Healthcare Provider Details

I. General information

NPI: 1053618025
Provider Name (Legal Business Name): JENNIFER LYNN KING CLC DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2011
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 LINCOLN AVE STE 1
LISLE IL
60532-4166
US

IV. Provider business mailing address

5035 LINCOLN AVE STE 1
LISLE IL
60532-4166
US

V. Phone/Fax

Practice location:
  • Phone: 630-999-7432
  • Fax: 630-214-3150
Mailing address:
  • Phone: 630-999-7432
  • Fax: 630-447-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number361338
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011816
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: