Provider Demographics
NPI:1568412039
Name:KING, DAVID R (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
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 1:1408 HAILEY ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-2508
Mailing Address - Country:US
Mailing Address - Phone:325-235-9355
Mailing Address - Fax:325-235-1011
Practice Address - Street 1:1408 HAILEY ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-2508
Practice Address - Country:US
Practice Address - Phone:325-235-9355
Practice Address - Fax:325-235-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV03148Medicare UPIN
TX8D0357Medicare ID - Type UnspecifiedIND. #