Provider Demographics
NPI:1275518417
Name:KLASSEN, TOBY LEROY (DC)
Entity Type:Individual
Prefix:DR
First Name:TOBY
Middle Name:LEROY
Last Name:KLASSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13418 US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:BARAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49908-9063
Mailing Address - Country:US
Mailing Address - Phone:906-353-6445
Mailing Address - Fax:
Practice Address - Street 1:13418 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:BARAGA
Practice Address - State:MI
Practice Address - Zip Code:49908-9063
Practice Address - Country:US
Practice Address - Phone:906-353-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1084570Medicaid
MI1084570Medicaid
MI0Z75000Medicare ID - Type Unspecified