MEDICARE: BRUCE KING D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6702	TX

General Provider Information

NPI Number	:	1033391255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE KING D.C.

Provider Business Mailing Address
First Line	:	6420 RICHMOND AVE
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77057-5929
Country	:	US
Telephone Number	:	713-626-8484
Fax Number	:

Provider Business Practice Location Address
First Line	:	6420 RICHMOND AVE
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77057-5929
Country	:	US
Telephone Number	:	713-626-8484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	11/29/2007

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