1316956121 NPI number — DR. TERAH MARIE LYNN MCCLAIN DC

Table of content: DR. TERAH MARIE LYNN MCCLAIN DC (NPI 1316956121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316956121 NPI number — DR. TERAH MARIE LYNN MCCLAIN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLAIN
Provider First Name:
TERAH
Provider Middle Name:
MARIE LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1316956121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-443-8060
Provider Business Mailing Address Fax Number:
406-449-7818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 ASPEN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-0905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-443-8060
Provider Business Practice Location Address Fax Number:
406-449-7818
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1063 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0165464 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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