Provider Demographics
NPI:1457361495
Name:KING, DOREEN I (DC)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:I
Last Name:KING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7363 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 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
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635510OtherBC/BS
IL212179Medicare ID - Type Unspecified