Healthcare Provider Details

I. General information

NPI: 1336256189
Provider Name (Legal Business Name): MICHAEL ALAN HORN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ORCHARD TER
BURLINGTON VT
05401-3866
US

IV. Provider business mailing address

545 OAK CIR
COLCHESTER VT
05446-5884
US

V. Phone/Fax

Practice location:
  • Phone: 802-860-7122
  • Fax: 802-860-7122
Mailing address:
  • Phone: 802-233-4794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number0396
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: