Provider Demographics
NPI:1881667285
Name:KLAES CLINIC, INC.
Entity Type:Organization
Organization Name:KLAES CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLAES
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCN
Authorized Official - Phone:812-522-2240
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-0747
Mailing Address - Country:US
Mailing Address - Phone:812-522-2240
Mailing Address - Fax:812-522-9582
Practice Address - Street 1:1400 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2224
Practice Address - Country:US
Practice Address - Phone:812-522-2240
Practice Address - Fax:812-522-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN510000026A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100140440AMedicaid
380810Medicare ID - Type Unspecified