Provider Demographics
NPI:1598842114
Name:DAVIS, ROBERT KENT (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENT
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: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
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131885000Medicaid
T92953Medicare UPIN
WVDA0742862Medicare ID - Type Unspecified