Provider Demographics
NPI:1083706238
Name:KING, ROBERT M (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
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 1:380 W VISTA HERMOSA DR
Mailing Address - Street 2:#100
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-1999
Mailing Address - Country:US
Mailing Address - Phone:520-648-2225
Mailing Address - Fax:520-625-9777
Practice Address - Street 1:380 W VISTA HERMOSA DR
Practice Address - Street 2:#100
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-1999
Practice Address - Country:US
Practice Address - Phone:520-648-2225
Practice Address - Fax:520-625-9777
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41824Medicare UPIN