Provider Demographics
NPI:1346469798
Name:KING CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:KING CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-891-1011
Mailing Address - Street 1:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-0190
Mailing Address - Country:US
Mailing Address - Phone:706-891-1011
Mailing Address - Fax:706-891-1013
Practice Address - Street 1:4205 CLOUD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736
Practice Address - Country:US
Practice Address - Phone:706-891-1011
Practice Address - Fax:706-891-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBVPMedicare ID - Type Unspecified
GAU25268Medicare UPIN