Provider Demographics
NPI:1629396205
Name:KING, DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
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 1:355 NORTHLAND DR NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 NORTHLAND DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1417
Practice Address - Country:US
Practice Address - Phone:616-866-6083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60129795111N00000X
MI2301009757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor