Provider Demographics
NPI:1023381043
Name:VAUGHN CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:VAUGHN CHIROPRACTIC PLLC
Other - Org Name:HEALTHSOURCE OF BLAINE CHIROPRACTIC & PROGRESSIVE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-205-3781
Mailing Address - Street 1:10904 BALTIMORE ST NE
Mailing Address - Street 2:STE 103
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5061
Mailing Address - Country:US
Mailing Address - Phone:763-205-3781
Mailing Address - Fax:
Practice Address - Street 1:10904 BALTIMORE ST NE
Practice Address - Street 2:STE 103
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5061
Practice Address - Country:US
Practice Address - Phone:763-205-3781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty