Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4468-012 | WI |
N | 111NN1001X | Nutrition | 4468-012 | WI |
NPI | 1568649044 |
---|---|
Provider Name | Dr. Terry John King II |
First Address | Slinger, WI 53086-9137 |
Second Address | Slinger, WI 53086-9137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2008 |
Last Update Date | 18/08/2010 |