Provider Demographics
NPI:1508087404
Name:DAVIS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DAVIS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-441-4484
Mailing Address - Street 1:213 GHANER DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1172
Mailing Address - Country:US
Mailing Address - Phone:814-441-4484
Mailing Address - Fax:814-234-0395
Practice Address - Street 1:311 S ALLEN ST
Practice Address - Street 2:STE. 3
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4857
Practice Address - Country:US
Practice Address - Phone:814-441-4484
Practice Address - Fax:814-234-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA093781UJFMedicare ID - Type Unspecified
PAV00031Medicare UPIN