Provider Demographics
NPI:1336109297
Name:KING, MERCER L (DC DABCA)
Entity Type:Individual
Prefix:DR
First Name:MERCER
Middle Name:L
Last Name:KING
Suffix:
Gender:M
Credentials:DC DABCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1896 HUDSON CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3549
Mailing Address - Country:US
Mailing Address - Phone:318-396-8010
Mailing Address - Fax:
Practice Address - Street 1:1896 HUDSON CIR STE 3
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3549
Practice Address - Country:US
Practice Address - Phone:318-396-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA721309854OtherTAX IDENTIFICATION NUMBER
LA1989827Medicaid
LA1989827Medicaid
LAT20106Medicare UPIN