Provider Demographics
NPI:1073625869
Name:DAVENPORT, DANIEL B (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:DAVENPORT
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 1:942 E. CHAMBERS ST.
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403
Mailing Address - Country:US
Mailing Address - Phone:801-475-7625
Mailing Address - Fax:801-476-7074
Practice Address - Street 1:942 E. CHAMBERS ST.
Practice Address - Street 2:SUITE 11
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-475-7625
Practice Address - Fax:801-476-7074
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6141291-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor