Provider Demographics
NPI:1205296936
Name:KRENEK CHIROPRACTIC
Entity type:Organization
Organization Name:KRENEK CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:KRENEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:979-236-9800
Mailing Address - Street 1:626 E BRAZOS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:TX
Mailing Address - Zip Code:77486-2946
Mailing Address - Country:US
Mailing Address - Phone:979-345-6325
Mailing Address - Fax:
Practice Address - Street 1:626 E BRAZOS AVE
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-2946
Practice Address - Country:US
Practice Address - Phone:979-345-6325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXDC8705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1548366842OtherINDIVIDUAL NPI
TXTXB106165OtherMEDICARE PTAN
TXTXB106165OtherMEDICARE PTAN