Provider Demographics
NPI:1134488729
Name:CALIFORNIA OAKS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:CALIFORNIA OAKS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRUTHAUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-698-2511
Mailing Address - Street 1:40710 CALIFORNIA OAKS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5727
Mailing Address - Country:US
Mailing Address - Phone:951-698-2511
Mailing Address - Fax:951-698-0108
Practice Address - Street 1:40710 CALIFORNIA OAKS RD
Practice Address - Street 2:SUITE A
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5727
Practice Address - Country:US
Practice Address - Phone:951-698-2511
Practice Address - Fax:951-698-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0194680Medicare PIN
DC0195070Medicare PIN