=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740586965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOUIS A. KING D.C.P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2011
-----------------------------------------------------
Last Update Date | 09/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2163 BIRCH SQ SUITE A
-----------------------------------------------------
City | LAKE HAVASU CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86403-6757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-680-4446
-----------------------------------------------------
Fax | 928-680-6565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1366
-----------------------------------------------------
City | LAKE HAVASU CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86405-1366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-680-4446
-----------------------------------------------------
Fax | 928-680-6565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. LOUIS A. KING
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 928-680-4446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4614
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------