Provider Demographics
NPI:1376766063
Name:DAVIS, WILLIAM B (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:BRENT
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1567 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1264
Mailing Address - Country:US
Mailing Address - Phone:716-877-0676
Mailing Address - Fax:716-877-4248
Practice Address - Street 1:1567 MILITARY RD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1264
Practice Address - Country:US
Practice Address - Phone:716-877-0676
Practice Address - Fax:716-877-4248
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020119601OtherUNIVERA
NY000206168001OtherBLUE CROSS
NYRB8585Medicare PIN
NY000206168001OtherBLUE CROSS
NYT26033Medicare UPIN