Provider Demographics
NPI:1508036674
Name:DAVIS, GREGG D (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:D
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 1:2565 N. CHARLEBOIS RD.
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85219-8635
Mailing Address - Country:US
Mailing Address - Phone:480-220-4567
Mailing Address - Fax:
Practice Address - Street 1:2565 N. CHARLEBOIS RD.
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85219-8635
Practice Address - Country:US
Practice Address - Phone:480-220-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5232111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician