MEDICARE: VAUGHN CHIROPRACTIC LLC

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	CHIRO007531	GA

General Provider Information

NPI Number	:	1588025944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAUGHN CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	3754 HIRAM ACWORTH HWY
Second Line	:	SUITE A
City	:	DALLAS
State	:	GA
Zip	:	30157-3275
Country	:	US
Telephone Number	:	770-443-0090
Fax Number	:	770-443-0070

Provider Business Practice Location Address
First Line	:	3754 HIRAM ACWORTH HWY
Second Line	:	SUITE A
City	:	DALLAS
State	:	GA
Zip	:	30157-3275
Country	:	US
Telephone Number	:	770-443-0090
Fax Number	:	770-443-0070

Authorized Official
Title or Position	:	OWNER/ CHIROPRACTOR
Name	:	DR. JASON PATRICK VAUGHN
Credential	:	DC
Telephone Number	:	770-443-0090

Provider Enumeration Date	:	03/14/2016
Last Update Date	:	03/14/2016

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