Provider Demographics
NPI:1710016332
Name:KING, GEORGE LEON (DC, MA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:LEON
Last Name:KING
Suffix:
Gender:M
Credentials:DC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-3008
Mailing Address - Country:US
Mailing Address - Phone:731-855-1960
Mailing Address - Fax:731-855-1710
Practice Address - Street 1:1100 S HIGH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-3008
Practice Address - Country:US
Practice Address - Phone:731-855-1960
Practice Address - Fax:731-855-1710
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2002981OtherBLUECROSS BLUESHIELD TN
TN4410416OtherAETNA
TN3673625Medicare ID - Type Unspecified
TN4410416OtherAETNA