Provider Demographics
NPI:1891119459
Name:MAHONEY FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MAHONEY FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-655-2664
Mailing Address - Street 1:150 WATERTOWER CIR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-1900
Mailing Address - Country:US
Mailing Address - Phone:802-655-2664
Mailing Address - Fax:802-655-8260
Practice Address - Street 1:150 WATERTOWER CIR
Practice Address - Street 2:SUITE 203
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-1900
Practice Address - Country:US
Practice Address - Phone:802-655-2664
Practice Address - Fax:802-655-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty