Provider Demographics
NPI:1093716789
Name:SCOTT M. VAUGHAN, D.C., P.C.
Entity Type:Organization
Organization Name:SCOTT M. VAUGHAN, D.C., P.C.
Other - Org Name:MCKENZIE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-726-2129
Mailing Address - Street 1:2479 OAKMONT WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6460
Mailing Address - Country:US
Mailing Address - Phone:541-726-2129
Mailing Address - Fax:541-654-4322
Practice Address - Street 1:2479 OAKMONT WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6460
Practice Address - Country:US
Practice Address - Phone:541-726-2129
Practice Address - Fax:541-654-4322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTT M. VAUGHAN DC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-03
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR131533Medicare PIN