Provider Demographics
NPI:1881633055
Name:KING, GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
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 1:5610 BETHELVIEW RD STE 300A
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-7523
Mailing Address - Country:US
Mailing Address - Phone:770-888-4288
Mailing Address - Fax:678-947-3203
Practice Address - Street 1:5610 BETHELVIEW RD STE 300A
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-7523
Practice Address - Country:US
Practice Address - Phone:770-999-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO005842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR005842OtherGA CHIRO LICENSE
GA202I356908Medicare PIN