Provider Demographics
NPI:1124192828
Name:KING, BILLIE (DC)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2104 RAYMOND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-2300
Mailing Address - Country:US
Mailing Address - Phone:601-373-1310
Mailing Address - Fax:601-373-6804
Practice Address - Street 1:6351 I 55 N
Practice Address - Street 2:STE 121
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7861
Practice Address - Country:US
Practice Address - Phone:601-373-1310
Practice Address - Fax:601-373-6804
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121269Medicaid
MS00121269Medicaid