Provider Demographics
NPI:1245217884
Name:KLASSY, THOMAS M (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:KLASSY
Suffix:
Gender:
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:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:MCCLOUD
Mailing Address - State:CA
Mailing Address - Zip Code:96057-0777
Mailing Address - Country:US
Mailing Address - Phone:415-510-9596
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 777
Practice Address - Street 2:
Practice Address - City:MCCLOUD
Practice Address - State:CA
Practice Address - Zip Code:96057-0777
Practice Address - Country:US
Practice Address - Phone:415-510-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-26
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath
No175L00000XOther Service ProvidersHomeopath
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Multi-Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0230310Medicaid
CADC0230310Medicaid
CADC0230311Medicare ID - Type Unspecified