Provider Demographics
NPI:1962560219
Name:KING, NEIL E (DC)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:E
Last Name:KING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 N FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-8025
Mailing Address - Country:US
Mailing Address - Phone:208-375-9993
Mailing Address - Fax:208-375-9993
Practice Address - Street 1:679 N FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-8025
Practice Address - Country:US
Practice Address - Phone:208-375-9993
Practice Address - Fax:208-375-9993
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC-514-7OtherBC PROVIDER #
IDC-514-7OtherBC PROVIDER #