Provider Demographics
NPI:1124387212
Name:DAVIS, MICHAEL KENNY (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENNY
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 1:712 N SNSHN STRIP STE 35
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8897
Mailing Address - Country:US
Mailing Address - Phone:956-203-9854
Mailing Address - Fax:
Practice Address - Street 1:712 N SNSHN STRIP STE 35
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8897
Practice Address - Country:US
Practice Address - Phone:956-203-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4786171100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB153795OtherINDIVIDUAL PTAN
TX1124387212OtherNPI