Provider Demographics
NPI:1841949260
Name:VAUGHAN, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COMMERCE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9198
Mailing Address - Country:US
Mailing Address - Phone:610-869-3222
Mailing Address - Fax:
Practice Address - Street 1:1 COMMERCE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9198
Practice Address - Country:US
Practice Address - Phone:610-869-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATBD111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor