Provider Demographics
NPI:1093734550
Name:DAVIS, TODD (DC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
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 1:200 W LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-1465
Mailing Address - Country:US
Mailing Address - Phone:330-868-4452
Mailing Address - Fax:330-868-6105
Practice Address - Street 1:200 W LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-1465
Practice Address - Country:US
Practice Address - Phone:330-868-4452
Practice Address - Fax:330-868-6105
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2033258Medicaid
OH2033258Medicaid
OHDA0897381Medicare ID - Type Unspecified