Provider Demographics
NPI:1023192374
Name:KAUTZ KOCH, ELIZABETH V (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:V
Last Name:KAUTZ KOCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:VIRGINIA
Other - Last Name:KAUTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1569 JEFFERSON HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2277
Mailing Address - Country:US
Mailing Address - Phone:540-943-0022
Mailing Address - Fax:540-942-3330
Practice Address - Street 1:1569 JEFFERSON HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2277
Practice Address - Country:US
Practice Address - Phone:540-943-0022
Practice Address - Fax:540-942-3330
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA261199OtherANTHEM PROVIDER #
VA269523OtherSOUTHERN HEALTH PROVIDER
VA00V012M80Medicare PIN
VA261199OtherANTHEM PROVIDER #