Provider Demographics
NPI:1558623603
Name:KING, NATHAN D (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:D
Last Name:KING
Suffix:
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 1:79 NOBLE AVE
Mailing Address - Street 2:APT 2C
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4740
Mailing Address - Country:US
Mailing Address - Phone:413-348-8264
Mailing Address - Fax:
Practice Address - Street 1:1995 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5723
Practice Address - Country:US
Practice Address - Phone:203-259-4731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor