Provider Demographics
NPI:1053330795
Name:DAVIS, PAUL J (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
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 1:1203 E VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5622
Mailing Address - Country:US
Mailing Address - Phone:714-956-7530
Mailing Address - Fax:714-533-4141
Practice Address - Street 1:1203 E VERMONT AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5622
Practice Address - Country:US
Practice Address - Phone:714-956-7530
Practice Address - Fax:714-533-4141
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X111N00000X
CA111NX0800X111NX0800X
CA111NN0400X111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEH5352Medicare UPIN
CADC18076Medicare PIN