MEDICARE: DR. KEITH MICHAEL 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	111NN1001X	Nutrition Chiropractor	0104556076	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	116154	OTHER	VA	ANTHEM BC BS

General Provider Information

NPI Number	:	1568401818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH MICHAEL KING D.C.

Provider Business Mailing Address
First Line	:	123 HIGHLAND CT
Second Line	:
City	:	LURAY
State	:	VA
Zip	:	22835-1012
Country	:	US
Telephone Number	:	540-219-5840
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 E MAIN ST
Second Line	:
City	:	LURAY
State	:	VA
Zip	:	22835-1902
Country	:	US
Telephone Number	:	574-074-3333
Fax Number	:	540-743-1425

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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