Provider Demographics
NPI:1548366842
Name:KRENEK, DAVID SHANE (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SHANE
Last Name:KRENEK
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 1:626 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:979-848-3306
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:979-848-3306
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
10775118OtherCAQH
TX607049OtherBC/BS
TX162392801Medicaid
0071313OtherBLUE LINK
TX7953241OtherAETNA
652643OtherUHC
U86932Medicare UPIN
10775118OtherCAQH
TX607049OtherBC/BS