Provider Demographics
NPI:1508943119
Name:DAVIS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:DAVIS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-683-4100
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:106 MAIN STREET
Mailing Address - City:SOPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:25921-0010
Mailing Address - Country:US
Mailing Address - Phone:304-683-4100
Mailing Address - Fax:304-683-5043
Practice Address - Street 1:106 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOPHIA
Practice Address - State:WV
Practice Address - Zip Code:25921-0010
Practice Address - Country:US
Practice Address - Phone:304-683-4100
Practice Address - Fax:304-683-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131885000Medicaid
WV0131885000Medicaid
T92953Medicare UPIN