Provider Demographics
NPI:1578955407
Name:DAVIS, JEREMIAH EVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:EVAN
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 1:1567 MILITARY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1264
Mailing Address - Country:US
Mailing Address - Phone:716-877-0676
Mailing Address - Fax:716-877-4248
Practice Address - Street 1:1567 MILITARY RD STE 1
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1264
Practice Address - Country:US
Practice Address - Phone:716-877-0676
Practice Address - Fax:716-877-4248
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012603111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor