MEDICARE: KING CHIROPRACTIC 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	111NS0005X	Sports Physician Chiropractor	007080	IA

General Provider Information

NPI Number	:	1194973859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1749 E 54TH ST
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-2769
Country	:	US
Telephone Number	:	563-344-4926
Fax Number	:	563-344-8759

Provider Business Practice Location Address
First Line	:	1749 E 54TH ST
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-2769
Country	:	US
Telephone Number	:	563-344-4926
Fax Number	:	563-344-8759

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. PATRICK TEE KING
Credential	:	D.C.
Telephone Number	:	563-343-2275

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	09/05/2008

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Directions to “KING CHIROPRACTIC LLC ” Practice Location

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