Provider Demographics
NPI:1093811382
Name:BEUTTLER, CRAIG ALLEN (DC, FIAMA)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALLEN
Last Name:BEUTTLER
Suffix:
Gender:M
Credentials:DC, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 POSADA LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4058
Mailing Address - Country:US
Mailing Address - Phone:805-434-0888
Mailing Address - Fax:805-434-0934
Practice Address - Street 1:225 POSADA LN
Practice Address - Street 2:SUITE C
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4058
Practice Address - Country:US
Practice Address - Phone:805-434-0888
Practice Address - Fax:805-434-0934
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05647Medicare UPIN
CAWDC15135AMedicare ID - Type Unspecified