Healthcare Provider Details

I. General information

NPI: 1871992099
Provider Name (Legal Business Name): VANESSA KING D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 SAINT PETERS HOWELL RD STE H
SAINT PETERS MO
63376-2821
US

IV. Provider business mailing address

2705 SAINT PETERS HOWELL RD STE H
SAINT PETERS MO
63376-2821
US

V. Phone/Fax

Practice location:
  • Phone: 844-544-5437
  • Fax:
Mailing address:
  • Phone: 844-544-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2014027312
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: