Provider Demographics
NPI:1902816986
Name:DR. ROSS D. VAUGHAN
Entity Type:Organization
Organization Name:DR. ROSS D. VAUGHAN
Other - Org Name:DORMONT CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:D
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-531-6196
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DORMONT CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-09
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA001284-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA150360Medicare PIN
PAT28991Medicare UPIN
PA115698Medicare PIN