Provider Demographics
NPI:1063505543
Name:KAUTZ, KATY L (DC)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:L
Last Name:KAUTZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 HIGHWAY KK
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3345
Mailing Address - Country:US
Mailing Address - Phone:573-302-4444
Mailing Address - Fax:573-302-7903
Practice Address - Street 1:1190 HWY KK
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3345
Practice Address - Country:US
Practice Address - Phone:573-302-4444
Practice Address - Fax:573-302-7903
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002028005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor