Provider Demographics
NPI:1023436581
Name:KIMBERLY LORENZ PLLC
Entity type:Organization
Organization Name:KIMBERLY LORENZ PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-578-5950
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:OLTON
Mailing Address - State:TX
Mailing Address - Zip Code:79064-0395
Mailing Address - Country:US
Mailing Address - Phone:573-578-5950
Mailing Address - Fax:
Practice Address - Street 1:2150 COUNTY ROAD 120
Practice Address - Street 2:
Practice Address - City:OLTON
Practice Address - State:TX
Practice Address - Zip Code:79064-2205
Practice Address - Country:US
Practice Address - Phone:573-578-5950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370615Medicare PIN