Healthcare Provider Details

I. General information

NPI: 1326078601
Provider Name (Legal Business Name): VAUGHN R. DITTO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E SANGER ST
HOBBS NM
88240-4403
US

IV. Provider business mailing address

205 E SANGER ST
HOBBS NM
88240-4403
US

V. Phone/Fax

Practice location:
  • Phone: 505-397-3356
  • Fax: 505-397-6107
Mailing address:
  • Phone: 505-397-3356
  • Fax: 505-397-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1097
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: