Provider Demographics
NPI:1427005404
Name:DAVIS, C J (DC)
Entity Type:Individual
Prefix:DR
First Name:C
Middle Name:J
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:PO BOX 1850
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0056
Mailing Address - Country:US
Mailing Address - Phone:360-385-0280
Mailing Address - Fax:360-385-5452
Practice Address - Street 1:1233 W SIMS WAY
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-3057
Practice Address - Country:US
Practice Address - Phone:360-385-0280
Practice Address - Fax:360-385-5452
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8861910Medicare PIN