Healthcare Provider Details

I. General information

NPI: 1861655730
Provider Name (Legal Business Name): KROGH FAMILY WELLNESS CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MAIN ST.
PANHANDLE TX
79068-1328
US

IV. Provider business mailing address

310 MAIN ST
PANHANDLE TX
79068-1328
US

V. Phone/Fax

Practice location:
  • Phone: 806-433-7459
  • Fax:
Mailing address:
  • Phone: 806-433-7459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number10915
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number10915
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number10915
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10915
License Number StateTX

VIII. Authorized Official

Name: DR. LANCE WILLIAM KROGH
Title or Position: OWNER
Credential: DC
Phone: 806-433-7459