Provider Demographics
NPI:1689446502
Name:KING, DAVID JAY (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAY
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 1:10355 NW GLENCOE RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINS
Mailing Address - State:OR
Mailing Address - Zip Code:97133-8244
Mailing Address - Country:US
Mailing Address - Phone:971-254-9988
Mailing Address - Fax:971-239-1906
Practice Address - Street 1:10355 NW GLENCOE RD STE B
Practice Address - Street 2:
Practice Address - City:NORTH PLAINS
Practice Address - State:OR
Practice Address - Zip Code:97133-8244
Practice Address - Country:US
Practice Address - Phone:971-254-9988
Practice Address - Fax:971-239-1906
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor