MEDICARE: DR. MABBETT KING RECKORD D.C.

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	CH3509	FL

General Provider Information

NPI Number	:	1629121173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MABBETT KING RECKORD D.C.

Provider Business Mailing Address
First Line	:	2027 E EDGEWOOD DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-3601
Country	:	US
Telephone Number	:	863-665-9597
Fax Number	:	863-665-1588

Provider Business Practice Location Address
First Line	:	2027 E EDGEWOOD DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-3601
Country	:	US
Telephone Number	:	863-665-9597
Fax Number	:	863-665-1588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/09/2007

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