Provider Demographics
NPI:1861655730
Name:KROGH FAMILY WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:KROGH FAMILY WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KROGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-433-7459
Mailing Address - Street 1:310 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PANHANDLE
Mailing Address - State:TX
Mailing Address - Zip Code:79068-1328
Mailing Address - Country:US
Mailing Address - Phone:806-433-7459
Mailing Address - Fax:
Practice Address - Street 1:310 MAIN ST.
Practice Address - Street 2:
Practice Address - City:PANHANDLE
Practice Address - State:TX
Practice Address - Zip Code:79068-1328
Practice Address - Country:US
Practice Address - Phone:806-433-7459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10915111N00000X, 111NN1001X, 111NP0017X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty