Provider Demographics
NPI:1306947270
Name:KREUTZ, MICHAEL L (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:KREUTZ
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 1:1502 N EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5906
Mailing Address - Country:US
Mailing Address - Phone:949-498-6440
Mailing Address - Fax:949-498-6441
Practice Address - Street 1:1502 N EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-5906
Practice Address - Country:US
Practice Address - Phone:949-498-6440
Practice Address - Fax:949-498-6441
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC14850Medicare ID - Type Unspecified