Provider Demographics
NPI:1417099011
Name:DAVIS, DEBORAH KATHLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:KATHLEEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15962 BOONES FERRY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4351
Mailing Address - Country:US
Mailing Address - Phone:503-699-9299
Mailing Address - Fax:503-699-0718
Practice Address - Street 1:15962 BOONES FERRY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4351
Practice Address - Country:US
Practice Address - Phone:503-699-9299
Practice Address - Fax:503-699-0718
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor