Provider Demographics
NPI:1306815246
Name:DR JOHN J DAVIDSON DC PA
Entity Type:Organization
Organization Name:DR JOHN J DAVIDSON DC PA
Other - Org Name:ULTIMATE HEALTH CHIROPRACTIC PHYSIOTHERAPY & SPORTS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:410-569-5969
Mailing Address - Street 1:2103 LAUREL BUSH RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015
Mailing Address - Country:US
Mailing Address - Phone:510-399-2225
Mailing Address - Fax:410-569-4454
Practice Address - Street 1:2103 LAUREL BUSH RD
Practice Address - Street 2:SUITE C
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:510-399-2225
Practice Address - Fax:410-569-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80409Medicare UPIN
MD537MMedicare ID - Type Unspecified