Provider Demographics
NPI:1396880936
Name:KING, JASON MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MATTHEW
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 1:5409 PATTERSON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2003
Mailing Address - Country:US
Mailing Address - Phone:804-608-3045
Mailing Address - Fax:804-523-8012
Practice Address - Street 1:5409 PATTERSON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2003
Practice Address - Country:US
Practice Address - Phone:804-608-3045
Practice Address - Fax:804-523-8012
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor