Provider Demographics
NPI:1245403757
Name:JACQUELINE C VAUGHN DC PC
Entity Type:Organization
Organization Name:JACQUELINE C VAUGHN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-674-4898
Mailing Address - Street 1:3093 SASHABAW
Mailing Address - Street 2:STE B
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329
Mailing Address - Country:US
Mailing Address - Phone:248-674-4898
Mailing Address - Fax:248-674-4905
Practice Address - Street 1:3093 SASHABAW
Practice Address - Street 2:STE B
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4089
Practice Address - Country:US
Practice Address - Phone:248-674-4898
Practice Address - Fax:248-674-4905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35184Medicare PIN
MIT33392Medicare UPIN