Provider Demographics
NPI:1659501682
Name:DAVIES, DAVID JASON (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JASON
Last Name:DAVIES
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 1:1456 N HOWE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-2754
Mailing Address - Country:US
Mailing Address - Phone:910-454-0909
Mailing Address - Fax:910-454-0911
Practice Address - Street 1:1456 N HOWE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2754
Practice Address - Country:US
Practice Address - Phone:910-454-0909
Practice Address - Fax:910-454-0911
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor