Provider Demographics
NPI:1134315450
Name:DAVIS CHIROPRACTIC HEALTH & WELLNESS, P.A
Entity Type:Organization
Organization Name:DAVIS CHIROPRACTIC HEALTH & WELLNESS, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-326-1804
Mailing Address - Street 1:204 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2607
Mailing Address - Country:US
Mailing Address - Phone:218-326-1804
Mailing Address - Fax:218-999-7660
Practice Address - Street 1:204 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2607
Practice Address - Country:US
Practice Address - Phone:218-326-1804
Practice Address - Fax:218-999-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1851408033OtherINDIVIDUAL NPI