Provider Demographics
NPI:1528549433
Name:DAVIS, MAHLON LEE (ND)
Entity Type:Individual
Prefix:DR
First Name:MAHLON
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 UNDERCLYFFE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-1037
Mailing Address - Country:US
Mailing Address - Phone:774-488-2929
Mailing Address - Fax:
Practice Address - Street 1:1129 MAIN ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2601
Practice Address - Country:US
Practice Address - Phone:802-321-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0000135175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath