Provider Demographics
NPI:1932473600
Name:KEITH NORMAN KAUSLER DC INC-A
Entity Type:Organization
Organization Name:KEITH NORMAN KAUSLER DC INC-A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:KAUSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-838-8931
Mailing Address - Street 1:14151 NEWPORT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-5163
Mailing Address - Country:US
Mailing Address - Phone:714-838-8931
Mailing Address - Fax:714-838-1114
Practice Address - Street 1:14151 NEWPORT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-5163
Practice Address - Country:US
Practice Address - Phone:714-838-8931
Practice Address - Fax:714-838-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC11950Medicaid
T17228Medicare UPIN
CADC11950Medicaid