Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 610 | VT |
N | 111NI0013X | Independent Medical Examiner | 610 | VT |
NPI | 1942371349 |
---|---|
Provider Name | Dr. Charles H. Mclean |
First Address | Burlington, VT 05401-5008 |
Second Address | Burlington, VT 05401-5008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 16/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101451100 | ACS - DEPT OF LABOR (FED) (01) | |
8747 | BCBSVT (01) | VT |