Provider Demographics
NPI:1851926802
Name:KAUTZ, KENDRA (DC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:KAUTZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 30TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3436
Mailing Address - Country:US
Mailing Address - Phone:562-453-5026
Mailing Address - Fax:
Practice Address - Street 1:204 30TH ST APT A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3436
Practice Address - Country:US
Practice Address - Phone:949-478-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor