Provider Demographics
NPI:1285690974
Name:VAUGHN, ROBERT MAURICE (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MAURICE
Last Name:VAUGHN
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288
Mailing Address - Country:US
Mailing Address - Phone:336-627-7398
Mailing Address - Fax:336-627-8421
Practice Address - Street 1:405 BOONE RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288
Practice Address - Country:US
Practice Address - Phone:336-627-7398
Practice Address - Fax:336-627-8421
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908899Medicaid
T64254Medicare UPIN
NC244172Medicare ID - Type Unspecified