Provider Demographics
NPI:1316217144
Name:VAUGHN, ROBERT LLOYD III (DC ATC ATR)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LLOYD
Last Name:VAUGHN
Suffix:III
Gender:M
Credentials:DC ATC ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10904 BALTIMORE ST. NE SUITE 1
Mailing Address - Street 2:103
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449
Mailing Address - Country:US
Mailing Address - Phone:763-205-3781
Mailing Address - Fax:763-205-3781
Practice Address - Street 1:10904 BALTIMORE ST NE STE 103
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5062
Practice Address - Country:US
Practice Address - Phone:763-242-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor