Provider Demographics
NPI:1801927611
Name:VAUGHAN, ADAM RICHARD (ATC)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:RICHARD
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1051 W US ROUTE 6 STE 400
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3370
Mailing Address - Country:US
Mailing Address - Phone:815-942-8301
Mailing Address - Fax:815-942-8449
Practice Address - Street 1:1306 GEMINI CIR STE 3
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1695
Practice Address - Country:US
Practice Address - Phone:815-431-9980
Practice Address - Fax:815-431-9981
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer