Provider Demographics
NPI:1447297668
Name:VAUGHN, ROBERT WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 W OTTAWA ST
Mailing Address - Street 2:P.O. BOX 311
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-4090
Mailing Address - Country:US
Mailing Address - Phone:217-379-3400
Mailing Address - Fax:217-379-3444
Practice Address - Street 1:1502 W OTTAWA ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-4090
Practice Address - Country:US
Practice Address - Phone:217-379-3400
Practice Address - Fax:217-379-3444
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1026618OtherBLUE CROSS
IL593500Medicare ID - Type Unspecified