Provider Demographics
NPI:1225754898
Name:KAUFMAN, CRAIG LOUIS
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:LOUIS
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 VILLA CT
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7722
Mailing Address - Country:US
Mailing Address - Phone:310-927-2708
Mailing Address - Fax:
Practice Address - Street 1:14623 HAWTHORNE BLVD STE 309
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1590
Practice Address - Country:US
Practice Address - Phone:310-927-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor