Healthcare Provider Details

I. General information

NPI: 1841361151
Provider Name (Legal Business Name): RONALD LYNN VAUGHT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 CICERO AVE STE 100
OAK FOREST IL
60452-1480
US

IV. Provider business mailing address

15000 CICERO AVE STE 100
OAK FOREST IL
60452-1480
US

V. Phone/Fax

Practice location:
  • Phone: 708-388-1522
  • Fax: 708-388-2880
Mailing address:
  • Phone: 708-388-1522
  • Fax: 708-388-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038-006400
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: