Provider Demographics
NPI:1235151689
Name:KING, JAMES WILLARD JR (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLARD
Last Name:KING
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11930 HERITAGE OAK PL
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2458
Mailing Address - Country:US
Mailing Address - Phone:530-888-6676
Mailing Address - Fax:
Practice Address - Street 1:11930 HERITAGE OAK PL
Practice Address - Street 2:SUITE # 3
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2458
Practice Address - Country:US
Practice Address - Phone:530-888-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU16762Medicare UPIN
CADC 0202530Medicare ID - Type Unspecified