Provider Demographics
NPI:1306161344
Name:KING CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:KING CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-539-7387
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-0813
Mailing Address - Country:US
Mailing Address - Phone:719-539-7387
Mailing Address - Fax:719-539-6038
Practice Address - Street 1:28350 COUNTY ROAD 317
Practice Address - Street 2:STE 3
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-9228
Practice Address - Country:US
Practice Address - Phone:719-539-7387
Practice Address - Fax:719-539-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty