Provider Demographics
NPI:1619267085
Name:DAVIS, MIRANDA LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:LEIGH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 REAVIS BARRACKS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-2438
Mailing Address - Country:US
Mailing Address - Phone:314-531-8882
Mailing Address - Fax:314-892-2701
Practice Address - Street 1:3641 REAVIS BARRACKS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-2438
Practice Address - Country:US
Practice Address - Phone:314-531-8882
Practice Address - Fax:314-892-2701
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011005884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor