Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | S01339 | MD |
NPI | 1003916222 |
---|---|
Provider Name | Mr. Vaughan Dabbs |
First Address | Clarksville, MD 21029-1600 |
Second Address | Columbia, MD 21045-1982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 27/11/2007 |