Provider Demographics
NPI:1992824742
Name:KING CHIROPRACTIC SPECIALISTS, INC.
Entity Type:Organization
Organization Name:KING CHIROPRACTIC SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-209-1155
Mailing Address - Street 1:7363 W. NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1230
Mailing Address - Country:US
Mailing Address - Phone:708-209-1155
Mailing Address - Fax:708-209-1926
Practice Address - Street 1:7363 W. NORTH AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1230
Practice Address - Country:US
Practice Address - Phone:708-209-1155
Practice Address - Fax:708-209-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1457361495OtherINDIVIDUAL NPI
IL1457361495OtherINDIVIDUAL NPI