Provider Demographics
NPI:1174530539
Name:VAUGHAN, JOHN B (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
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 1:589 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:S DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-2516
Mailing Address - Country:US
Mailing Address - Phone:508-997-5636
Mailing Address - Fax:508-717-6267
Practice Address - Street 1:589 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:S DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748-2516
Practice Address - Country:US
Practice Address - Phone:508-997-5636
Practice Address - Fax:508-717-6267
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA35370OtherHARVARDPILGRIM
MA1331266001OtherCIGNA
MAVA Y35528OtherBLUECROSS/BLUESHIELD
MAVA Y35528OtherBLUECROSS/BLUESHIELD
MAY35528Medicare ID - Type Unspecified