Provider Demographics
NPI:1902050453
Name:VITAL ENERGY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:VITAL ENERGY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-443-8060
Mailing Address - Street 1:1300 ASPEN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-0905
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000004499Medicare PIN