Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 6529 | CO |
N | 111NN1001X | Nutrition | 31790 | CA |
NPI | 1639450380 |
---|---|
Provider Name | Dr. Lindy Vaughn |
First Address | San Mateo, CA 94403-1808 |
Second Address | San Mateo, CA 94403-1808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2011 |
Last Update Date | 16/01/2015 |