Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 848 | NC |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 848 | NC |
NPI | 1285810044 |
---|---|
Provider Name | Dr. Mack Herron King III |
First Address | Charlotte, NC 28205 |
Second Address | Charlotte, NC 28205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2008 |
Last Update Date | 11/01/2008 |