Provider Demographics
NPI:1942479522
Name:KAUFMAN, STEPHEN WALLACE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WALLACE
Last Name:KAUFMAN
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 1:624 W CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2819
Mailing Address - Country:US
Mailing Address - Phone:714-744-6074
Mailing Address - Fax:714-744-1458
Practice Address - Street 1:624 W CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2819
Practice Address - Country:US
Practice Address - Phone:714-744-6074
Practice Address - Fax:714-744-1458
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 23661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23661Medicare PIN