Provider Demographics
NPI:1356669576
Name:KLASSEN, ADAM MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MARK
Last Name:KLASSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ADAM
Other - Middle Name:MARK
Other - Last Name:KLASSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:700 MURDOCK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1426
Mailing Address - Country:US
Mailing Address - Phone:360-855-1021
Mailing Address - Fax:360-855-0356
Practice Address - Street 1:700 MURDOCK ST
Practice Address - Street 2:SUITE B
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1426
Practice Address - Country:US
Practice Address - Phone:360-855-1021
Practice Address - Fax:360-855-0356
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60145297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8892097Medicare PIN