Provider Demographics
NPI:1124044011
Name:VAUGHN, KI ROSS (DC)
Entity Type:Individual
Prefix:DR
First Name:KI
Middle Name:ROSS
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N US HIGHWAY 1
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2218
Mailing Address - Country:US
Mailing Address - Phone:561-743-0363
Mailing Address - Fax:561-744-9839
Practice Address - Street 1:731 N US HIGHWAY 1
Practice Address - Street 2:SUITE 5
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2218
Practice Address - Country:US
Practice Address - Phone:561-743-0363
Practice Address - Fax:561-744-9839
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0460ZMedicare PIN