Provider Demographics
NPI:1508930900
Name:DAVIS, JAMES PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
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 1:1706 BRADY ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4712
Mailing Address - Country:US
Mailing Address - Phone:563-650-5645
Mailing Address - Fax:563-322-6228
Practice Address - Street 1:1706 BRADY ST
Practice Address - Street 2:SUITE 104
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-4712
Practice Address - Country:US
Practice Address - Phone:563-650-5645
Practice Address - Fax:563-322-6228
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05075111N00000X
IL038005319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0225987Medicaid
IA22598Medicare UPIN
IA0225987Medicaid
901640Medicare ID - Type Unspecified