Provider Demographics
NPI:1790795771
Name:VAUGHAN, ROSS D (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:D
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 1:300 MT LEBANON BLVD
Mailing Address - Street 2:SUITE 2205
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234
Mailing Address - Country:US
Mailing Address - Phone:412-531-6196
Mailing Address - Fax:412-531-6626
Practice Address - Street 1:300 MT LEBANON BLVD
Practice Address - Street 2:SUITE 2205
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234
Practice Address - Country:US
Practice Address - Phone:412-531-6196
Practice Address - Fax:412-531-6626
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001284-L111N00000X
PA001284-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T28991Medicare UPIN
PA115698Medicare PIN