Provider Demographics
NPI:1003987330
Name:DAVIS, WILLIAM GORDON SR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GORDON
Last Name:DAVIS
Suffix:SR
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 1:3625 MIRIAM DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2975
Mailing Address - Country:US
Mailing Address - Phone:321-264-1767
Mailing Address - Fax:
Practice Address - Street 1:1096 CONCORD PKWY N STE 5
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5930
Practice Address - Country:US
Practice Address - Phone:704-793-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6473111N00000X
NC4445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U46434Medicare UPIN
U46434Medicare UPIN