Provider Demographics
NPI:1376716654
Name:DAVIS, WAYNE BYRON (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:BYRON
Last Name:DAVIS
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 1:1715 5TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7911
Mailing Address - Country:US
Mailing Address - Phone:563-650-4169
Mailing Address - Fax:
Practice Address - Street 1:863 S PERRYVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-4328
Practice Address - Country:US
Practice Address - Phone:779-423-2044
Practice Address - Fax:779-423-2045
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06529111N00000X
IL038.011236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1447559935OtherNATIONAL PROVIDER IDENTIFIER