Provider Demographics
NPI:1124127782
Name:BLAUT, STEVEN J
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:BLAUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 KOA AVE
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1707
Mailing Address - Country:US
Mailing Address - Phone:805-772-1467
Mailing Address - Fax:
Practice Address - Street 1:1052 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-4004
Practice Address - Country:US
Practice Address - Phone:805-772-4419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC13458Medicare ID - Type Unspecified
CA05029Medicare UPIN