Provider Demographics
NPI:1215378823
Name:KAUTZ, CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:KAUTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 FOGG ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-4656
Mailing Address - Country:US
Mailing Address - Phone:615-669-5252
Mailing Address - Fax:
Practice Address - Street 1:632 FOGG ST STE 15
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-4896
Practice Address - Country:US
Practice Address - Phone:615-669-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4948-12111N00000X
KY5385111N00000X
TN2669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor