Provider Demographics
NPI:1346486610
Name:THREE KINGS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:THREE KINGS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:DOMENIC
Authorized Official - Last Name:CAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-376-3068
Mailing Address - Street 1:7512 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE50, PMB 505
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5131
Mailing Address - Country:US
Mailing Address - Phone:407-376-3068
Mailing Address - Fax:
Practice Address - Street 1:660 CELEBRATION AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4924
Practice Address - Country:US
Practice Address - Phone:321-939-3180
Practice Address - Fax:407-442-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty