Provider Demographics
NPI:1437229598
Name:VAUGHN, THOMAS RAYMOND JR (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RAYMOND
Last Name:VAUGHN
Suffix:JR
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 1:2211 N RAMPART BLVD # 118
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7640
Mailing Address - Country:US
Mailing Address - Phone:702-369-7222
Mailing Address - Fax:
Practice Address - Street 1:2832 E LAKE MEAD BLVD STE F
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6550
Practice Address - Country:US
Practice Address - Phone:702-369-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU05329Medicare UPIN
NVDC483Medicare ID - Type Unspecified