Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 10915 | TX |
N | 111NP0017X | Pediatric Chiropractor | 10915 | TX |
NPI | 1750523569 |
---|---|
Provider Name | Lance Krogh |
First Address | Pampa, TX 79065-5126 |
Second Address | Pampa, TX 79065-5126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2009 |
Last Update Date | 14/03/2011 |