Provider Demographics
NPI:1598363384
Name:DAVIS, CODY JAMES (DC)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:JAMES
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 1:6308 JASPER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1592
Mailing Address - Country:US
Mailing Address - Phone:817-368-3985
Mailing Address - Fax:
Practice Address - Street 1:4540 W BAILEY BOSWELL RD STE 170
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-4439
Practice Address - Country:US
Practice Address - Phone:817-497-8961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor