Provider Demographics
NPI:1528097771
Name:KLENCK, CHRIS A (MD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:A
Last Name:KLENCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 LAKE LOUDON BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-4009
Mailing Address - Country:US
Mailing Address - Phone:865-475-4484
Mailing Address - Fax:
Practice Address - Street 1:1551 LAKE LOUDON BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-2674
Practice Address - Country:US
Practice Address - Phone:865-475-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060568A207QS0010X
TN41783207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7827802OtherAETNA
TNTN01L8OtherJOHN DEERE HEALTHCARE
TNP00903946OtherRAILROAD MEDICARE
TN4140843OtherBLUECROSS BLUESHIELD
TN8832551OtherCIGNA
TN103I112598Medicare PIN
7827802OtherAETNA
TNP00903946OtherRAILROAD MEDICARE
TN4140843OtherBLUECROSS BLUESHIELD