Provider Demographics
NPI:1598934739
Name:DAVIS, RODNEY STUART (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:STUART
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 1224
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-1224
Mailing Address - Country:US
Mailing Address - Phone:970-375-2465
Mailing Address - Fax:970-247-0351
Practice Address - Street 1:117 COUNTY ROAD 250
Practice Address - Street 2:UNIT C
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7519
Practice Address - Country:US
Practice Address - Phone:970-375-2465
Practice Address - Fax:970-247-0351
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA100978Medicare PIN