Provider Demographics
NPI:1295207025
Name:KING, CHRISTOPHER WARREN (BS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WARREN
Last Name:KING
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7224 W 400 N
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-2903
Mailing Address - Country:US
Mailing Address - Phone:219-879-4621
Mailing Address - Fax:
Practice Address - Street 1:7224 W 400 N
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-2903
Practice Address - Country:US
Practice Address - Phone:219-879-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator