Provider Demographics
NPI:1285810044
Name:KING, MACK HERRON III (DC)
Entity type:Individual
Prefix:DR
First Name:MACK
Middle Name:HERRON
Last Name:KING
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:3545 NORTH SHARON AMITY ROAD
Mailing Address - Street 2:KING CHIROPRACTIC CLINIC
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205
Mailing Address - Country:US
Mailing Address - Phone:170-442-6111
Mailing Address - Fax:170-442-6133
Practice Address - Street 1:3545 NORTH SHARON AMITY ROAD
Practice Address - Street 2:KING CHIROPRACTIC CLINIC
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205
Practice Address - Country:US
Practice Address - Phone:170-442-6111
Practice Address - Fax:170-442-6133
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC848111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic