Provider Demographics
NPI:1376824763
Name:DRWENCKE, KRYSTAL MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:MARIE
Last Name:DRWENCKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 OXMOOR RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3505
Mailing Address - Country:US
Mailing Address - Phone:205-803-1234
Mailing Address - Fax:
Practice Address - Street 1:61 GOUGH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5901
Practice Address - Country:US
Practice Address - Phone:415-881-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor