Provider Demographics
NPI:1114088002
Name:KING, JOSEPH L (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
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 1:11 LAKESIDE OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1309
Mailing Address - Country:US
Mailing Address - Phone:781-246-4433
Mailing Address - Fax:781-246-4468
Practice Address - Street 1:11 LAKESIDE OFFICE PARK
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1309
Practice Address - Country:US
Practice Address - Phone:781-246-4433
Practice Address - Fax:781-246-4468
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA722111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35521Medicare ID - Type Unspecified