Provider Demographics
NPI:1750523569
Name:KROGH, LANCE (DC)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:KROGH
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 1:701 N PRICE RD
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-5126
Mailing Address - Country:US
Mailing Address - Phone:806-665-7261
Mailing Address - Fax:806-665-0537
Practice Address - Street 1:701 N PRICE RD
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-5126
Practice Address - Country:US
Practice Address - Phone:806-665-7261
Practice Address - Fax:806-665-0537
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10915111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor