Provider Demographics
NPI:1033794581
Name:BATES, DAVIS (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:
Last Name:BATES
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 1:7400 METRO BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2321
Mailing Address - Country:US
Mailing Address - Phone:952-207-2186
Mailing Address - Fax:
Practice Address - Street 1:7400 METRO BLVD STE 222
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2321
Practice Address - Country:US
Practice Address - Phone:952-207-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor