Individual
VAUGHN ROGER FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
414 SOUTH BEECH STREET, MOSES LAKE, WA 98837
(509) 765-9235
(509) 765-9235
Mailing address
414 SOUTH BEECH STREET, MOSES LAKE, WA 98837
(509) 765-9235
(509) 765-9235
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH00003350
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111104
STATE DLI
WA
01
—
FAIVA0200461618
PREMERA BLUE CROSS
WA
Enumeration date
05/02/2007
Last updated
07/08/2007
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