Provider Demographics
NPI:1043238272
Name:DAVIS, CHARLES A (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
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 1:204 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-1402
Mailing Address - Country:US
Mailing Address - Phone:515-532-3162
Mailing Address - Fax:515-532-3162
Practice Address - Street 1:204 1ST ST NE
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-1402
Practice Address - Country:US
Practice Address - Phone:515-532-3162
Practice Address - Fax:515-532-3162
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0106054Medicaid
IA13830OtherWELLMARK BC BS
IA0106054Medicaid