Provider Demographics
NPI:1083796247
Name:DAVIS, PAUL C (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
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 1:16023 WYNFIELD CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5628
Mailing Address - Country:US
Mailing Address - Phone:704-953-0081
Mailing Address - Fax:
Practice Address - Street 1:552 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9227
Practice Address - Country:US
Practice Address - Phone:704-664-6932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2456869Medicare ID - Type Unspecified
NCU97282Medicare UPIN