Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 12496 | TX |
NPI | 1003237025 |
---|---|
Provider Name | Heather Dawn King |
First Address | Austin, TX 78759-2322 |
Second Address | Austin, TX 78759-2322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2013 |
Last Update Date | 17/12/2013 |