Provider Demographics
NPI:1467542910
Name:CLAASSEN, MICHAEL GORDON (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GORDON
Last Name:CLAASSEN
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 1:208 S. ELM ST.
Mailing Address - Street 2:PO BOX 336
Mailing Address - City:WHITEWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67154
Mailing Address - Country:US
Mailing Address - Phone:316-799-2779
Mailing Address - Fax:316-799-2752
Practice Address - Street 1:208 S. ELM ST.
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:KS
Practice Address - Zip Code:67154
Practice Address - Country:US
Practice Address - Phone:316-799-2779
Practice Address - Fax:316-799-2752
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-00917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor