Provider Demographics
NPI:1952698987
Name:LORENZ, KYLE SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:SCOTT
Last Name:LORENZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7356 STOCKMAN ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-6006
Mailing Address - Country:US
Mailing Address - Phone:307-632-3399
Mailing Address - Fax:307-632-2050
Practice Address - Street 1:7356 STOCKMAN ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-6006
Practice Address - Country:US
Practice Address - Phone:307-632-3399
Practice Address - Fax:307-632-2050
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor