1316217144 NPI number — DR. ROBERT LLOYD VAUGHN III D.C. ATC. ATR

Table of content: DR. ROBERT LLOYD VAUGHN III D.C. ATC. ATR (NPI 1316217144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316217144 NPI number — DR. ROBERT LLOYD VAUGHN III D.C. ATC. ATR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAUGHN
Provider First Name:
ROBERT
Provider Middle Name:
LLOYD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.C. ATC. ATR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316217144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10904 BALTIMORE ST. NE SUITE 1
Provider Second Line Business Mailing Address:
103
Provider Business Mailing Address City Name:
BLAINE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-205-3781
Provider Business Mailing Address Fax Number:
763-205-3781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10904 BALTIMORE ST NE STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55449-5062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-242-4271
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5587 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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