Provider Demographics
NPI:1679787196
Name:KLASSEN, ANDREA DIANE (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DIANE
Last Name:KLASSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 N SAGINAW BLVD STE D1
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1100
Mailing Address - Country:US
Mailing Address - Phone:817-232-8900
Mailing Address - Fax:817-232-8544
Practice Address - Street 1:1029 N SAGINAW BLVD STE D1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1100
Practice Address - Country:US
Practice Address - Phone:817-232-8900
Practice Address - Fax:817-232-8544
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU87308Medicare UPIN
TX8833J1Medicare ID - Type UnspecifiedPART B