Provider Demographics
NPI:1225241144
Name:MOVSES, VAUGHN ANTHONY (D,C,)
Entity Type:Individual
Prefix:
First Name:VAUGHN
Middle Name:ANTHONY
Last Name:MOVSES
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:VAUGHN
Other - Middle Name:ANTHONY
Other - Last Name:MOVSES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17100 N 67TH LANE SUITE 300
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:818-201-6996
Mailing Address - Fax:
Practice Address - Street 1:17100 W 67TH AVE SUITE 300
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:818-201-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor