Provider Demographics
NPI:1003365727
Name:KING, WARREN (LAC)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15612 HIGHWAY 7
Mailing Address - Street 2:SUITE 252
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3543
Mailing Address - Country:US
Mailing Address - Phone:952-930-3575
Mailing Address - Fax:
Practice Address - Street 1:15612 HIGHWAY 7
Practice Address - Street 2:SUITE 252
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3543
Practice Address - Country:US
Practice Address - Phone:952-930-3575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1065171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist