Healthcare Provider Details

I. General information

NPI: 1861569576
Provider Name (Legal Business Name): ROBERT A KING D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PINE VALLEY RD
LOCUST GROVE VA
22508-5426
US

IV. Provider business mailing address

208 PINE VALLEY RD
LOCUST GROVE VA
22508-5426
US

V. Phone/Fax

Practice location:
  • Phone: 540-972-1111
  • Fax:
Mailing address:
  • Phone: 540-972-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104000533
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: