Provider Demographics
NPI:1659372340
Name:VAUGHAN, SCOTT M (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:VAUGHAN
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 1:2479 OAKMONT WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6460
Mailing Address - Country:US
Mailing Address - Phone:541-726-2129
Mailing Address - Fax:
Practice Address - Street 1:2479 OAKMONT WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6460
Practice Address - Country:US
Practice Address - Phone:541-726-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR131534Medicare PIN
U49483Medicare UPIN