Provider Demographics
NPI:1326078601
Name:DITTO, VAUGHN R (DC)
Entity Type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:R
Last Name:DITTO
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 1:205 E SANGER ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-4403
Mailing Address - Country:US
Mailing Address - Phone:505-397-3356
Mailing Address - Fax:505-397-6107
Practice Address - Street 1:205 E SANGER ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-4403
Practice Address - Country:US
Practice Address - Phone:505-397-3356
Practice Address - Fax:505-397-6107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1097111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMU02499Medicare ID - Type Unspecified