Provider Demographics
NPI:1720291289
Name:KING CHIROPRACTIC OF URBANA
Entity type:Organization
Organization Name:KING CHIROPRACTIC OF URBANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-874-9002
Mailing Address - Street 1:3280 URBANA PIKE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:URBANA
Mailing Address - State:MD
Mailing Address - Zip Code:21754
Mailing Address - Country:US
Mailing Address - Phone:301-874-9002
Mailing Address - Fax:301-869-5417
Practice Address - Street 1:19392 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3000
Practice Address - Country:US
Practice Address - Phone:301-926-5200
Practice Address - Fax:301-869-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1356413686OtherPERSONAL NPI NUMBER