Provider Demographics
NPI:1053453191
Name:DAVIS, O TROY (DC)
Entity Type:Individual
Prefix:DR
First Name:O
Middle Name:TROY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:321 N MALL DRIVE STE
Mailing Address - Street 2:STE H-102
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7341
Mailing Address - Country:US
Mailing Address - Phone:435-862-0125
Mailing Address - Fax:435-215-7680
Practice Address - Street 1:321 N MALL DR
Practice Address - Street 2:STE H- 102
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7341
Practice Address - Country:US
Practice Address - Phone:435-862-0125
Practice Address - Fax:435-215-7680
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY4683111N00000X
UT8328842-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU89361Medicare UPIN
GAU89361Medicare UPIN