Provider Demographics
NPI:1386182137
Name:KAUTZ CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:KAUTZ CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-349-7738
Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-0504
Mailing Address - Country:US
Mailing Address - Phone:563-289-3242
Mailing Address - Fax:563-289-4541
Practice Address - Street 1:126 1/2 S CODY RD
Practice Address - Street 2:
Practice Address - City:LE CLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-9236
Practice Address - Country:US
Practice Address - Phone:563-289-3242
Practice Address - Fax:563-289-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty