Provider Demographics
NPI:1174654727
Name:DAVIS, TRUDENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:TRUDENCE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4506
Mailing Address - Country:US
Mailing Address - Phone:760-724-6682
Mailing Address - Fax:760-724-6682
Practice Address - Street 1:866 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4506
Practice Address - Country:US
Practice Address - Phone:760-724-6682
Practice Address - Fax:760-724-6682
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC121770Medicare ID - Type UnspecifiedMEDICARE ID
CAT04655Medicare UPIN