Provider Demographics
NPI:1659350924
Name:DAVIS, CHARLES G (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:G
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 1:417 W FOOTHILL BLVD
Mailing Address - Street 2:#401
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-5301
Mailing Address - Country:US
Mailing Address - Phone:626-732-9611
Mailing Address - Fax:
Practice Address - Street 1:2028 E ROUTE 66
Practice Address - Street 2:#202
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4609
Practice Address - Country:US
Practice Address - Phone:626-732-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17458111NX0100X, 111NS0005X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology