Provider Demographics
NPI:1528180452
Name:KING, MICHELLE M (DC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
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 1:21 WILLIAMSBURG LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2225
Mailing Address - Country:US
Mailing Address - Phone:530-898-1470
Mailing Address - Fax:
Practice Address - Street 1:21 WILLIAMSBURG LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2225
Practice Address - Country:US
Practice Address - Phone:530-898-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU85297Medicare UPIN
CADC0262120Medicare ID - Type Unspecified