MEDICARE: KING DIAGNOSTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1140	OH

General Provider Information

NPI Number	:	1043466915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING DIAGNOSTIC LLC

Provider Business Mailing Address
First Line	:	391 FALLRIVER DR
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-7102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1349 MCNAUGHTEN RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-1678
Country	:	US
Telephone Number	:	614-582-2135
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN K GRANGER
Credential	:
Telephone Number	:	614-582-2135

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	08/12/2008

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Directions to “KING DIAGNOSTIC LLC ” Practice Location

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