Provider Demographics
NPI:1265745897
Name:VAUGHN, AMBER NICOLE (BS, DC)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:NICOLE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 KIRKWOOD BLVD
Mailing Address - Street 2:APT 1
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4575
Mailing Address - Country:US
Mailing Address - Phone:563-499-4611
Mailing Address - Fax:
Practice Address - Street 1:2211 E 52ND ST
Practice Address - Street 2:SUITE D
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2771
Practice Address - Country:US
Practice Address - Phone:563-514-7509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-25
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor