| Healthsource Of Blaine Chiropractic & Progressive Rehab | |
|
10904 Baltimore St Ne, Ste 103, Blaine, MN 55449-5061 | |
| (763) 205-3781 | |
| Not Available |
| Full Name | Healthsource Of Blaine Chiropractic & Progressive Rehab |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 10904 Baltimore St Ne, Blaine, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023381043 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 5587 (Minnesota) | Primary |
| Provider Name | Robert Lloyd Vaughn |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1316217144 PECOS PAC ID: 8224299888 Enrollment ID: I20120409000568 |
| Mailing Address | Practice Location Address |
|---|---|
| Healthsource Of Blaine Chiropractic & Progressive Rehab 10904 Baltimore St Ne, Ste 103, Blaine, MN 55449-5061 Ph: (763) 205-3781 | Healthsource Of Blaine Chiropractic & Progressive Rehab 10904 Baltimore St Ne, Ste 103, Blaine, MN 55449-5061 Ph: (763) 205-3781 |
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