Provider Demographics
NPI:1609966191
Name:MAHONEY, SEAN PATRICK (CD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 LEDGEWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:HINESBURG
Mailing Address - State:TN
Mailing Address - Zip Code:05461
Mailing Address - Country:US
Mailing Address - Phone:802-482-3631
Mailing Address - Fax:
Practice Address - Street 1:150 WATER TOWER CIRCLE
Practice Address - Street 2:SUITE 203
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-655-2664
Practice Address - Fax:802-655-8260
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0000779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT5752OtherBC/BS
VT5752OtherBC/BS