Provider Demographics
NPI:1932216249
Name:REENTS, VAUGHN NEAL (DC)
Entity type:Individual
Prefix:
First Name:VAUGHN
Middle Name:NEAL
Last Name:REENTS
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 1:502 ELAINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-4684
Mailing Address - Country:US
Mailing Address - Phone:651-503-2974
Mailing Address - Fax:
Practice Address - Street 1:620 CIVIC HEIGHTS DR
Practice Address - Street 2:SUITE 108
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-4711
Practice Address - Country:US
Practice Address - Phone:763-795-8300
Practice Address - Fax:763-795-8302
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU68243Medicare UPIN