Provider Demographics
NPI:1255449344
Name:KING, THOMAS RILEY (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RILEY
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 1:2216 MEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5059
Mailing Address - Country:US
Mailing Address - Phone:734-971-1777
Mailing Address - Fax:
Practice Address - Street 1:2216 MEDFORD RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5059
Practice Address - Country:US
Practice Address - Phone:734-971-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITK008611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H151170Medicare ID - Type Unspecified