Healthcare Provider Details

I. General information

NPI: 1942277025
Provider Name (Legal Business Name): ROBERT L. VAUGHAN JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W WADE ST
TRENTON FL
32693-4159
US

IV. Provider business mailing address

325 W WADE ST
TRENTON FL
32693-4159
US

V. Phone/Fax

Practice location:
  • Phone: 135-246-3812
  • Fax: 135-246-3812
Mailing address:
  • Phone: 135-246-3812
  • Fax: 135-246-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4397
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: