Provider Demographics
NPI:1578731683
Name:PFAUTZ, L MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:L MICHAEL
Middle Name:
Last Name:PFAUTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25200 LA PAZ RD
Mailing Address - Street 2:102
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5110
Mailing Address - Country:US
Mailing Address - Phone:949-702-2344
Mailing Address - Fax:949-606-1970
Practice Address - Street 1:25200 LA PAZ RD
Practice Address - Street 2:102
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5110
Practice Address - Country:US
Practice Address - Phone:949-702-2344
Practice Address - Fax:949-060-1970
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23167OtherBOARD OF CHIROPRACTIC EXAMINERS
CAU72232Medicare UPIN