Provider Demographics
NPI:1437122298
Name:KING, CHARLES VANN II (DC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:VANN
Last Name:KING
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 LOGAN PL
Mailing Address - Street 2:
Mailing Address - City:CONFLUENCE
Mailing Address - State:PA
Mailing Address - Zip Code:15424-1022
Mailing Address - Country:US
Mailing Address - Phone:814-395-9800
Mailing Address - Fax:814-395-9803
Practice Address - Street 1:606 LOGAN PL
Practice Address - Street 2:
Practice Address - City:CONFLUENCE
Practice Address - State:PA
Practice Address - Zip Code:15424-1022
Practice Address - Country:US
Practice Address - Phone:814-395-9800
Practice Address - Fax:814-395-9803
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019528060001Medicaid
PA0019528060001Medicaid
PAU945538Medicare UPIN