Provider Demographics
NPI:1033400510
Name:DAVIS, THEODORE W (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:W
Last Name:DAVIS
Suffix:
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 1:2505 KACHINA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1573
Mailing Address - Country:US
Mailing Address - Phone:719-544-2009
Mailing Address - Fax:719-253-7734
Practice Address - Street 1:2505 KACHINA DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1573
Practice Address - Country:US
Practice Address - Phone:719-544-2009
Practice Address - Fax:719-253-7734
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor