MEDICARE: DR. MICHAEL RYAN VAUGHN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11534	TX

General Provider Information

NPI Number	:	1619281524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RYAN VAUGHN D.C.

Provider Business Mailing Address
First Line	:	560 E CENTRAL TEXAS EXPY
Second Line	:	SUITE 102
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-5606
Country	:	US
Telephone Number	:	254-698-1600
Fax Number	:	254-698-1605

Provider Business Practice Location Address
First Line	:	560 E CENTRAL TEXAS EXPY
Second Line	:	SUITE 102
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-5606
Country	:	US
Telephone Number	:	254-698-1600
Fax Number	:	254-698-1605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	11/10/2015

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