Provider Demographics
NPI:1366491870
Name:VAUGHN, CHARLES F III (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:VAUGHN
Suffix:III
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 1:920 RUTH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1154
Mailing Address - Country:US
Mailing Address - Phone:314-754-8466
Mailing Address - Fax:
Practice Address - Street 1:12258 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2501
Practice Address - Country:US
Practice Address - Phone:314-739-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO122599431327528OtherHEALTHLINK CUSTOMER ID
MO13770OtherBLUE CROSS
MO31001Medicare ID - Type UnspecifiedMEDICARE
MO122599431327528OtherHEALTHLINK CUSTOMER ID
MOT43455Medicare UPIN