MEDICARE: JASON PATRICK VAUGHN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR007531	GA

General Provider Information

NPI Number	:	1346445426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON PATRICK VAUGHN DC

Provider Business Mailing Address
First Line	:	3754 HIRAM ACWORTH HWY STE A
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-3275
Country	:	US
Telephone Number	:	770-443-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	3754 HIRAM ACWORTH HWY STE A
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-3275
Country	:	US
Telephone Number	:	770-443-0090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	02/12/2008

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