Provider Demographics
NPI:1588991764
Name:KING, ANN MARIE (DC)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:KING TARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:23479 SE STARK ST, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030
Mailing Address - Country:US
Mailing Address - Phone:360-903-1586
Mailing Address - Fax:503-618-0148
Practice Address - Street 1:23479 SE STARK ST, SUITE 101
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:360-903-1586
Practice Address - Fax:503-618-0148
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3945111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR270681658OtherTAX ID NUMBER