Provider Demographics
NPI:1609012475
Name:DAVISON, ROBERT ARLEN (D C)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ARLEN
Last Name:DAVISON
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1629
Mailing Address - Country:US
Mailing Address - Phone:925-683-1847
Mailing Address - Fax:
Practice Address - Street 1:2500 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2613
Practice Address - Country:US
Practice Address - Phone:510-843-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor