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General NPI Number Information
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NPI Number | 1861655730
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Entity Type | Organization
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Legal Business Name | KROGH FAMILY WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 310 MAIN ST.
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City | PANHANDLE
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State | TX
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Zip | 79068-1328
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Country | US
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Telephone | 806-433-7459
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Fax |
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Provider Business Mailing Address
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Address Line | 310 MAIN ST
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City | PANHANDLE
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State | TX
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Zip | 79068-1328
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Country | US
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Telephone | 806-433-7459
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LANCE WILLIAM KROGH
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Credential | DC
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Telephone | 806-433-7459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 10915
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | 10915
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 10915
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 10915
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License Number State | TX
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