Healthcare Provider Details

I. General information

NPI: 1942371349
Provider Name (Legal Business Name): CHARLES H. MCLEAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 SHELBURNE RD
BURLINGTON VT
05401-5008
US

IV. Provider business mailing address

507 SHELBURNE RD
BURLINGTON VT
05401-5008
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-5150
  • Fax: 802-860-0668
Mailing address:
  • Phone: 802-864-5150
  • Fax: 802-860-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number610
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number610
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: