Healthcare Provider Details

I. General information

NPI: 1265465504
Provider Name (Legal Business Name): BACK OF THE MOUNTAIN HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 MAIN ST
WEED CA
96094-2525
US

IV. Provider business mailing address

PO BOX 491689
REDDING CA
96049-1689
US

V. Phone/Fax

Practice location:
  • Phone: 530-938-0701
  • Fax: 530-938-0702
Mailing address:
  • Phone: 530-224-3322
  • Fax: 530-224-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC23031
License Number StateCA

VIII. Authorized Official

Name: THOMAS MICHAEL KLASSY
Title or Position: OWNER
Credential: D.C.
Phone: 530-938-0701