Provider Demographics
NPI:1437129004
Name:KING, MOLLY (DC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2888
Mailing Address - Country:US
Mailing Address - Phone:859-261-4858
Mailing Address - Fax:
Practice Address - Street 1:1510 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:KY
Practice Address - Zip Code:41011-2888
Practice Address - Country:US
Practice Address - Phone:859-261-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000990Medicaid
KY85000990Medicaid
KY0959101Medicare ID - Type Unspecified