Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 038-006601 | IL |
NPI | 1205048741 |
---|---|
Provider Name | Dr. Ronald G Vaughn |
First Address | Hoffman Estates, IL 60169 |
Second Address | Hoffman Estates, IL 60169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 31/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1618729 | (02) | IL |