=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942385711
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PFAUTZ CHIROPRACTIC CORPORATION, A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 03/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25200 LA PAZ RD 102
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-5110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-249-8007
-----------------------------------------------------
Fax | 949-606-1970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25200 LA PAZ RD 102
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-5110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-702-2344
-----------------------------------------------------
Fax | 949-606-1970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES OF CORP
-----------------------------------------------------
Name | DR. L MICHAEL PFAUTZ
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 949-702-2344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC23167
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------