Provider Demographics
NPI:1356511919
Name:MICHAEL DAVIS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MICHAEL DAVIS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-966-7771
Mailing Address - Street 1:5320 HIGHWAY 49 N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-9588
Mailing Address - Country:US
Mailing Address - Phone:209-966-7771
Mailing Address - Fax:
Practice Address - Street 1:5320 HIGHWAY 49 N
Practice Address - Street 2:SUITE 1
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9588
Practice Address - Country:US
Practice Address - Phone:209-966-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14584261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service