Healthcare Provider Details

I. General information

NPI: 1750459053
Provider Name (Legal Business Name): KEVIN M KING DC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N MAIN ST
NORTH BALTIMORE OH
45872-1136
US

IV. Provider business mailing address

311 N MAIN ST
NORTH BALTIMORE OH
45872-1136
US

V. Phone/Fax

Practice location:
  • Phone: 419-257-3571
  • Fax: 419-257-1311
Mailing address:
  • Phone: 419-257-3571
  • Fax: 419-257-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number884
License Number StateOH

VIII. Authorized Official

Name: DR. KEVIN M KING
Title or Position: PRESIDENT
Credential: DC
Phone: 419-257-3571