Provider Demographics
NPI:1689624348
Name:VAUGHN, DEREK SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:SCOTT
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4284 TRAIL BOSS DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7512
Mailing Address - Country:US
Mailing Address - Phone:303-688-0454
Mailing Address - Fax:303-688-9998
Practice Address - Street 1:4284 TRAIL BOSS DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7512
Practice Address - Country:US
Practice Address - Phone:303-688-0454
Practice Address - Fax:303-688-9998
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1801840319OtherGROUP NPI
CO805352Medicare PIN