Provider Demographics
NPI:1770587503
Name:KING, JOHN KELLY (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KELLY
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 1:8 YOUELL ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2019
Mailing Address - Country:US
Mailing Address - Phone:859-525-1213
Mailing Address - Fax:859-525-4016
Practice Address - Street 1:8 YOUELL ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2019
Practice Address - Country:US
Practice Address - Phone:859-525-1213
Practice Address - Fax:859-525-4016
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001329Medicaid
KY6079001Medicare ID - Type Unspecified