Provider Demographics
NPI:1619272598
Name:DAVIS, WADE ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:ALLEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:650 S HIGHWAY 27
Mailing Address - Street 2:STE 5-315
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-3501
Mailing Address - Country:US
Mailing Address - Phone:606-679-1991
Mailing Address - Fax:606-679-1149
Practice Address - Street 1:604 OGDEN ST
Practice Address - Street 2:STE 202
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1795
Practice Address - Country:US
Practice Address - Phone:606-679-1991
Practice Address - Fax:606-679-1149
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY5276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor