Provider Demographics
NPI:1265553671
Name:VAUGHT, WILLIAM DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:VAUGHT
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 1:8250 WATTERSON TRL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1196
Mailing Address - Country:US
Mailing Address - Phone:502-495-1133
Mailing Address - Fax:502-493-0880
Practice Address - Street 1:8250 WATTERSON TRL
Practice Address - Street 2:SUITE 2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1196
Practice Address - Country:US
Practice Address - Phone:502-495-1133
Practice Address - Fax:502-493-0880
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000364388OtherANTHEM
KY000000364388OtherANTHEM
KY0978201Medicare ID - Type Unspecified