Provider Demographics
NPI:1073507877
Name:DAVIS CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:DAVIS CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-477-0497
Mailing Address - Street 1:3711 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2744
Mailing Address - Country:US
Mailing Address - Phone:919-477-0497
Mailing Address - Fax:919-477-3384
Practice Address - Street 1:3711 N ROXBORO ST
Practice Address - Street 2:SUITE A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2744
Practice Address - Country:US
Practice Address - Phone:919-477-0497
Practice Address - Fax:919-477-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1704111N00000X
NC549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2453303Medicare PIN