Provider Demographics
NPI:1427220318
Name:VAUGHN, TRAVIS MICHEAL (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:MICHEAL
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:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541-0656
Mailing Address - Country:US
Mailing Address - Phone:360-482-5155
Mailing Address - Fax:360-482-5155
Practice Address - Street 1:2601 W FALLS AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3002
Practice Address - Country:US
Practice Address - Phone:509-579-0270
Practice Address - Fax:509-579-0270
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor