Healthcare Provider Details

I. General information

NPI: 1720291289
Provider Name (Legal Business Name): KING CHIROPRACTIC OF URBANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19392 MONTGOMERY VILLAGE AVE SUITE A
MONTGOMERY VILLAGE MD
20886-3000
US

IV. Provider business mailing address

3280 URBANA PIKE SUITE 206
URBANA MD
21754
US

V. Phone/Fax

Practice location:
  • Phone: 301-926-5200
  • Fax: 301-869-5417
Mailing address:
  • Phone: 301-874-9002
  • Fax: 301-869-5417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1208
License Number StateMD

VIII. Authorized Official

Name: DR. LARRY NEIL KING
Title or Position: OWNER
Credential: DC
Phone: 301-874-9002