Provider Demographics
NPI:1609852367
Name:KING, THERESA M (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
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 1:4035 SE 52ND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3913
Mailing Address - Country:US
Mailing Address - Phone:503-774-4099
Mailing Address - Fax:503-774-0106
Practice Address - Street 1:4035 SE 52ND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-3913
Practice Address - Country:US
Practice Address - Phone:503-774-4099
Practice Address - Fax:503-774-0106
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor