Provider Demographics
NPI:1376737148
Name:DAVIES, BRUCE EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:EDWARD
Last Name:DAVIES
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:PO BOX 1754
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28335-1754
Mailing Address - Country:US
Mailing Address - Phone:910-897-0200
Mailing Address - Fax:
Practice Address - Street 1:721 TILGHMAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6063
Practice Address - Country:US
Practice Address - Phone:910-897-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908967Medicaid