Provider Demographics
NPI:1275542284
Name:MAUGHAN, THOMAS RHETT (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RHETT
Last Name:MAUGHAN
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:PO BOX 783
Mailing Address - Street 2:P.O. BOX 783
Mailing Address - City:MONTICELLO
Mailing Address - State:UT
Mailing Address - Zip Code:84535-0783
Mailing Address - Country:US
Mailing Address - Phone:435-587-3255
Mailing Address - Fax:435-587-3442
Practice Address - Street 1:225 SO. MAIN
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:UT
Practice Address - Zip Code:84535
Practice Address - Country:US
Practice Address - Phone:435-587-3255
Practice Address - Fax:435-587-3442
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176449-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870395551005Medicaid
UT000056046Medicare ID - Type Unspecified