Provider Demographics
NPI:1316956121
Name:MCCLAIN, TERAH MARIE LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:TERAH
Middle Name:MARIE LYNN
Last Name:MCCLAIN
Suffix:
Gender:F
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:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624
Mailing Address - Country:US
Mailing Address - Phone:406-443-8060
Mailing Address - Fax:406-449-7818
Practice Address - Street 1:1300 ASPEN ST
Practice Address - Street 2:SUITE A
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-0905
Practice Address - Country:US
Practice Address - Phone:406-443-8060
Practice Address - Fax:406-449-7818
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0165464Medicaid
MT000004592Medicare ID - Type Unspecified