1144232612 NPI number — MCLAIN CHIROPRACTIC CENTER, PLLC

Table of content: (NPI 1144232612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144232612 NPI number — MCLAIN CHIROPRACTIC CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLAIN CHIROPRACTIC CENTER, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144232612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 BANK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03766-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-448-2515
Provider Business Mailing Address Fax Number:
603-448-2622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 BANK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03766-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-448-2515
Provider Business Practice Location Address Fax Number:
603-448-2622
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCLAIN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-448-2515

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  140-1153-0584A , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0508447Y0NH02 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 8447 . This is a "VT BLUE CROSS,BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 5071355 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 5224221 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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