=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295910354
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATIE S KING D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2008
-----------------------------------------------------
Last Update Date | 01/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 SPRING HILL RING RD STE 111
-----------------------------------------------------
City | WEST DUNDEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60118-7301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-915-4955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 WINDING CANYON WAY
-----------------------------------------------------
City | ALGONQUIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60102-5030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-955-1884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038.011092
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------