Healthcare Provider Details

I. General information

NPI: 1760525158
Provider Name (Legal Business Name): JANICE L KING RD, LDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 WEST MAIN STREET
WEST BROOKFIELD MA
01585
US

IV. Provider business mailing address

PO BOX 585 147 WEST MAIN STREET
WEST BROOKFIELD MA
01585-0585
US

V. Phone/Fax

Practice location:
  • Phone: 508-867-9735
  • Fax: 508-867-2600
Mailing address:
  • Phone: 508-867-9735
  • Fax: 508-867-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number1525
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: