Provider Demographics
NPI:1417118498
Name:KRIS DAVIS, DC, INC.
Entity Type:Organization
Organization Name:KRIS DAVIS, DC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-475-1800
Mailing Address - Street 1:PO BOX 150321
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0321
Mailing Address - Country:US
Mailing Address - Phone:801-475-1800
Mailing Address - Fax:801-475-0071
Practice Address - Street 1:1186 E 4600 S
Practice Address - Street 2:STE. 220
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4332
Practice Address - Country:US
Practice Address - Phone:801-475-1800
Practice Address - Fax:801-475-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3376391202302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization