=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386182137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAUTZ CHIROPRACTIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2017
-----------------------------------------------------
Last Update Date | 02/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 1/2 S CODY RD
-----------------------------------------------------
City | LE CLAIRE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52753-9236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-289-3242
-----------------------------------------------------
Fax | 563-289-4541
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 504
-----------------------------------------------------
City | LE CLAIRE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52753-0504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-289-3242
-----------------------------------------------------
Fax | 563-289-4541
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | COURTNEY KAUTZ
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 563-349-7738
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 085037
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------