Provider Demographics
NPI:1083676001
Name:MCCLAIN, GORDON KENT (DC,)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:KENT
Last Name:MCCLAIN
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 1:3058 LEECHBURG RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3460
Mailing Address - Country:US
Mailing Address - Phone:724-339-8611
Mailing Address - Fax:724-339-0313
Practice Address - Street 1:3058 LEECHBURG RD
Practice Address - Street 2:SUITE 7
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3460
Practice Address - Country:US
Practice Address - Phone:724-339-8611
Practice Address - Fax:724-339-0313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002749L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29246Medicare UPIN
PA120849Medicare ID - Type Unspecified