MEDICARE: DR. DEREK SCOTT 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	5812	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1801840319	OTHER	CO	GROUP NPI

General Provider Information

NPI Number	:	1689624348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK SCOTT VAUGHN D.C.

Provider Business Mailing Address
First Line	:	4284 TRAIL BOSS DR
Second Line	:	SUITE 120
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7512
Country	:	US
Telephone Number	:	303-688-0454
Fax Number	:	303-688-9998

Provider Business Practice Location Address
First Line	:	4284 TRAIL BOSS DR
Second Line	:	SUITE 120
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7512
Country	:	US
Telephone Number	:	303-688-0454
Fax Number	:	303-688-9998

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	09/03/2008

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