Provider Demographics
NPI:1114993375
Name:VAUGHN, CYNTHIA SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:SUE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:VAUGHN
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2500 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5257
Mailing Address - Country:US
Mailing Address - Phone:512-445-3366
Mailing Address - Fax:512-444-8283
Practice Address - Street 1:2500 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE 205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5257
Practice Address - Country:US
Practice Address - Phone:512-445-3366
Practice Address - Fax:512-444-8283
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU08448Medicare UPIN
TX85800KMedicare ID - Type Unspecified