Healthcare Provider Details

I. General information

NPI: 1366491870
Provider Name (Legal Business Name): CHARLES F VAUGHN III D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12258 SAINT CHARLES ROCK RD
BRIDGETON MO
63044-2501
US

IV. Provider business mailing address

920 RUTH DR
SAINT CHARLES MO
63301-1154
US

V. Phone/Fax

Practice location:
  • Phone: 314-739-7979
  • Fax:
Mailing address:
  • Phone: 314-754-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number005016
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: