Provider Demographics
NPI:1376782342
Name:MCCLAIN CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MCCLAIN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-838-6083
Mailing Address - Street 1:2640 NORTH HIGHWAY 67
Mailing Address - Street 2:NOT APPLICABLE
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1438
Mailing Address - Country:US
Mailing Address - Phone:314-838-6083
Mailing Address - Fax:314-838-8994
Practice Address - Street 1:2640 N. HWY. 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1438
Practice Address - Country:US
Practice Address - Phone:314-838-6083
Practice Address - Fax:314-838-8994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE006098111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU88142Medicare UPIN