=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457651713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL L KREUTZ CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2010
-----------------------------------------------------
Last Update Date | 11/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1502 N EL CAMINO REAL
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92672-5906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-498-6440
-----------------------------------------------------
Fax | 949-498-6441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1502 N EL CAMINO REAL
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92672-5906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-498-6440
-----------------------------------------------------
Fax | 949-498-6441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL L KREUTZ
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 949-498-6440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC14850
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------