Healthcare Provider Details

I. General information

NPI: 1609966191
Provider Name (Legal Business Name): SEAN PATRICK MAHONEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5031 MAIN ST
WAITSFIELD VT
05673-7464
US

IV. Provider business mailing address

324 LEDGEWOOD LN
HINESBURG VT
05461-9544
US

V. Phone/Fax

Practice location:
  • Phone: 802-496-9206
  • Fax: 802-855-9220
Mailing address:
  • Phone: 802-496-9206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006-0000779
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: