Provider Demographics
NPI:1235215609
Name:DAVIDSON, EUGENE MERLE (DC)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:MERLE
Last Name:DAVIDSON
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 1:945 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-2427
Mailing Address - Country:US
Mailing Address - Phone:785-483-3580
Mailing Address - Fax:
Practice Address - Street 1:138 W 7TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-1905
Practice Address - Country:US
Practice Address - Phone:785-483-5356
Practice Address - Fax:785-483-3535
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor