Provider Demographics
NPI:1508066804
Name:DAVIS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DAVIS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-856-6466
Mailing Address - Street 1:502 W MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2322
Mailing Address - Country:US
Mailing Address - Phone:302-856-6466
Mailing Address - Fax:302-856-6618
Practice Address - Street 1:502 W MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2322
Practice Address - Country:US
Practice Address - Phone:302-856-6466
Practice Address - Fax:302-856-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U10927OtherUPIN
660178Medicare PIN