Provider Demographics
NPI:1588668388
Name:DAVIS, MARK JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
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 1:940 GEMINI ST
Mailing Address - Street 2:STE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2763
Mailing Address - Country:US
Mailing Address - Phone:281-486-1675
Mailing Address - Fax:281-486-1677
Practice Address - Street 1:940 GEMINI ST
Practice Address - Street 2:STE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2763
Practice Address - Country:US
Practice Address - Phone:281-486-1675
Practice Address - Fax:281-486-1677
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2692OtherCHIROPRACITIC LICENSE NO.
TX6835675002OtherCIGNA
TX600967OtherBCBS PROVIDER NO.
TX256563OtherHEALTHASSURANCE WPA
TXP1590568OtherOXFORD HEALTHPLANS
TN877177ZOtherRENAISSANCE PHY NETWORK
TX4300584OtherAETNA
TX2589763OtherHEALTHMARKET
TX256563OtherHEALTHASSURANCE WPA
TX2692OtherCHIROPRACITIC LICENSE NO.