Provider Demographics
NPI:1790907715
Name:KING, GARY GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:GEORGE
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 1:7429 CONROY WINDERMERE ROAD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835
Mailing Address - Country:US
Mailing Address - Phone:407-253-5351
Mailing Address - Fax:407-822-5351
Practice Address - Street 1:7429 CONROY WINDERMERE ROAD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835
Practice Address - Country:US
Practice Address - Phone:407-253-5351
Practice Address - Fax:407-822-5351
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor