Provider Demographics
NPI:1629121173
Name:RECKORD, MABBETT KING (DC)
Entity Type:Individual
Prefix:DR
First Name:MABBETT
Middle Name:KING
Last Name:RECKORD
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 1:2027 E EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3601
Mailing Address - Country:US
Mailing Address - Phone:863-665-9597
Mailing Address - Fax:863-665-1588
Practice Address - Street 1:2027 E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3601
Practice Address - Country:US
Practice Address - Phone:863-665-9597
Practice Address - Fax:863-665-1588
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88575Medicare ID - Type UnspecifiedMEDICARE#
FLT85872Medicare UPIN