Provider Demographics
NPI:1104966779
Name:KRENZELOK, ALTON JOHN
Entity type:Individual
Prefix:
First Name:ALTON
Middle Name:JOHN
Last Name:KRENZELOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 RANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2774
Mailing Address - Country:US
Mailing Address - Phone:307-433-8853
Mailing Address - Fax:307-433-8854
Practice Address - Street 1:520 RANDALL AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2774
Practice Address - Country:US
Practice Address - Phone:307-433-8853
Practice Address - Fax:307-433-8854
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYU70405Medicare UPIN
WY9183Medicare ID - Type Unspecified