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General NPI Number Information
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NPI Number | 1891968830
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Entity Type | Organization
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Legal Business Name | THERESA M KING, DC, PC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 4035 SE 52ND AVE SUITE B
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City | PORTLAND
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State | OR
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Zip | 97206-3913
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Country | US
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Telephone | 503-774-4099
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Fax | 503-774-0106
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Provider Business Mailing Address
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Address Line | 4035 SE 52ND AVE SUITE B
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City | PORTLAND
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State | OR
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Zip | 97206-3913
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Country | US
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Telephone | 503-774-4099
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Fax | 503-774-0106
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Authorized Official
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Title or Position | PRESIDENT/SECRETARY
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Name | DR. THERESA M KING
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Credential | DC
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Telephone | 503-774-4099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 27 2850
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License Number State | OR
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