Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC002749L | PA |
NPI | 1083676001 |
---|---|
Provider Name | Dr. Gordon Kent Mcclain |
First Address | Lower Burrell, PA 15068-3460 |
Second Address | Lower Burrell, PA 15068-3460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T29246 | (02) | PA |