Provider Demographics
NPI:1598833584
Name:GAUTREAU, STEVEN K (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:K
Last Name:GAUTREAU
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 1:14650 AVIATION BLVD., SUITE 225
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6656
Mailing Address - Country:US
Mailing Address - Phone:310-536-9996
Mailing Address - Fax:310-536-9997
Practice Address - Street 1:14650 AVIATION BLVD STE 225
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6656
Practice Address - Country:US
Practice Address - Phone:310-536-9996
Practice Address - Fax:310-536-9997
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29053111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician