Provider Demographics
NPI:1467039362
Name:KING CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KING CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:844-212-5321
Mailing Address - Street 1:2309 W DR MARTIN LUTHER KING JR BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6439
Mailing Address - Country:US
Mailing Address - Phone:813-624-6947
Mailing Address - Fax:813-930-5963
Practice Address - Street 1:2309 W DR MARTIN LUTHER KING JR BLVD STE 5
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6439
Practice Address - Country:US
Practice Address - Phone:813-624-6947
Practice Address - Fax:214-975-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty