Healthcare Provider Details

I. General information

NPI: 1346331576
Provider Name (Legal Business Name): DAVID JAMES VAUGHN III D.C., CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3684 HIGHWAY 150 STE 8
FLOYDS KNOBS IN
47119-9692
US

IV. Provider business mailing address

3502 LANCASTER DR
NEW ALBANY IN
47150-2268
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-9679
  • Fax:
Mailing address:
  • Phone: 502-298-4053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4514
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001950A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: