Provider Demographics
NPI:1154066561
Name:DAVIS HEALTH & WELLNESS CLINIC, P.C.
Entity Type:Organization
Organization Name:DAVIS HEALTH & WELLNESS CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:573-891-1250
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0603
Mailing Address - Country:US
Mailing Address - Phone:573-891-1250
Mailing Address - Fax:573-891-1320
Practice Address - Street 1:808 SPECIALITY DR STE A
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2753
Practice Address - Country:US
Practice Address - Phone:573-891-1250
Practice Address - Fax:573-891-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care