Provider Demographics
NPI:1952332363
Name:DR. K. MICHAEL KING CHRIOPRACTOR PLLC
Entity Type:Organization
Organization Name:DR. K. MICHAEL KING CHRIOPRACTOR PLLC
Other - Org Name:HEALTH4LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-743-3333
Mailing Address - Street 1:1137 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-1683
Mailing Address - Country:US
Mailing Address - Phone:540-743-3333
Mailing Address - Fax:540-743-1425
Practice Address - Street 1:1137 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1683
Practice Address - Country:US
Practice Address - Phone:540-743-3333
Practice Address - Fax:540-743-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556076111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA116152OtherANTHEM GROUP #
VA116152OtherANTHEM GROUP #