Provider Demographics
NPI:1285841429
Name:DAVIS, MICHAEL WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:714 POLLASKY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1840
Mailing Address - Country:US
Mailing Address - Phone:559-325-5700
Mailing Address - Fax:559-325-5755
Practice Address - Street 1:714 POLLASKY AVE.
Practice Address - Street 2:SUITE 101
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612
Practice Address - Country:US
Practice Address - Phone:559-325-5700
Practice Address - Fax:559-325-5755
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2013-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA14584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0145840Medicare UPIN