Provider Demographics
NPI:1912907304
Name:LAUT, STEVEN RAY (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RAY
Last Name:LAUT
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:PO BOX 31
Mailing Address - Street 2:794 N. MAPLE GR. AVE.
Mailing Address - City:HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:49247-0031
Mailing Address - Country:US
Mailing Address - Phone:517-448-8515
Mailing Address - Fax:517-448-3044
Practice Address - Street 1:794 N MAPLE GROVE AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247-1148
Practice Address - Country:US
Practice Address - Phone:517-448-8515
Practice Address - Fax:517-448-3044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL173693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4343700Medicaid
MISL004913OtherPRIVATE PROVIDER ID #
MI4343700Medicaid