Healthcare Provider Details

I. General information

NPI: 1467039362
Provider Name (Legal Business Name): KING CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 W DR MARTIN LUTHER KING JR BLVD STE 5
TAMPA FL
33607-6439
US

IV. Provider business mailing address

2309 W DR MARTIN LUTHER KING JR BLVD STE 5
TAMPA FL
33607-6439
US

V. Phone/Fax

Practice location:
  • Phone: 813-624-6947
  • Fax: 214-975-2270
Mailing address:
  • Phone: 813-624-6947
  • Fax: 813-930-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: FRANK GRAY III
Title or Position: DIRECTOR
Credential:
Phone: 844-212-5321