Provider Demographics
NPI:1659607703
Name:KING CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:KING CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-395-5066
Mailing Address - Street 1:5917 OLEANDER DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4781
Mailing Address - Country:US
Mailing Address - Phone:910-395-5066
Mailing Address - Fax:910-395-5068
Practice Address - Street 1:5917 OLEANDER DR
Practice Address - Street 2:SUITE 106
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4781
Practice Address - Country:US
Practice Address - Phone:910-395-5066
Practice Address - Fax:910-395-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty