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General NPI Number Information
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NPI Number | 1013334994
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Entity Type | Individual
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Provider Name | SHANE CHITTENDEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 25359 KINSALE PL
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City | ALDIE
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State | VA
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Zip | 20105-3066
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Country | US
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Telephone | 571-228-9881
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Fax |
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Provider Business Mailing Address
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Address Line | 25359 KINSALE PL
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City | ALDIE
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State | VA
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Zip | 20105-3066
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 0102202034
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207ZF0201X
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Taxonomy Name | Forensic Pathology Physician
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License Number | 20A12674
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License Number State | CA
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