Provider Demographics
NPI:1346445426
Name:VAUGHN, JASON PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:PATRICK
Last Name:VAUGHN
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 1:3754 HIRAM ACWORTH HWY STE A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-3275
Mailing Address - Country:US
Mailing Address - Phone:770-443-0090
Mailing Address - Fax:
Practice Address - Street 1:3754 HIRAM ACWORTH HWY STE A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-3275
Practice Address - Country:US
Practice Address - Phone:770-443-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHWTMedicare PIN