MEDICARE: KING SPINAL & SPORTS REHABILITATION, LTD.

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	038005195	IL
2	225100000X	Physical Therapist	070009347	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	06032044	OTHER		BC/BS OF ILLINOIS

General Provider Information

NPI Number	:	1427157593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING SPINAL & SPORTS REHABILITATION, LTD.

Provider Business Mailing Address
First Line	:	PO BOX 943
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-0943
Country	:	US
Telephone Number	:	618-452-1986
Fax Number	:	618-452-6814

Provider Business Practice Location Address
First Line	:	1525 JOHNSON RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-3831
Country	:	US
Telephone Number	:	618-452-1986
Fax Number	:	618-452-6814

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES E KING JR.
Credential	:	D.C.
Telephone Number	:	618-452-1986

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	04/02/2026

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Directions to “KING SPINAL & SPORTS REHABILITATION, LTD. ” Practice Location

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