Provider Demographics
NPI:1265781819
Name:DRENZEK CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:DRENZEK CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRENIER-DRENZEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-241-2183
Mailing Address - Street 1:2211 10TH AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-2502
Mailing Address - Country:US
Mailing Address - Phone:414-766-9390
Mailing Address - Fax:414-766-9392
Practice Address - Street 1:2211 10TH AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-2502
Practice Address - Country:US
Practice Address - Phone:414-766-9390
Practice Address - Fax:414-766-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4092-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty