Provider Demographics
NPI:1942371349
Name:MCLEAN, CHARLES H (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 SHELBURNE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5008
Mailing Address - Country:US
Mailing Address - Phone:802-864-5150
Mailing Address - Fax:802-860-0668
Practice Address - Street 1:507 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5008
Practice Address - Country:US
Practice Address - Phone:802-864-5150
Practice Address - Fax:802-860-0668
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT610111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
101451100OtherACS - DEPT OF LABOR (FED)
VT8747OtherBCBSVT
VTVT8747Medicare ID - Type UnspecifiedMEDICARE