Provider Demographics
NPI:1265465504
Name:BACK OF THE MOUNTAIN HEALTHCARE
Entity Type:Organization
Organization Name:BACK OF THE MOUNTAIN HEALTHCARE
Other - Org Name:THOMAS KLASSY, D.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KLASSY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-938-0701
Mailing Address - Street 1:PO BOX 491689
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-1689
Mailing Address - Country:US
Mailing Address - Phone:530-224-3322
Mailing Address - Fax:530-224-3325
Practice Address - Street 1:295 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEED
Practice Address - State:CA
Practice Address - Zip Code:96094-2525
Practice Address - Country:US
Practice Address - Phone:530-938-0701
Practice Address - Fax:530-938-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0230310Medicaid
CADC0230310Medicaid
CAU49136Medicare UPIN