Provider Demographics
NPI:1659785525
Name:DAVIS, HEATHER CATHERINE (DC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:CATHERINE
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 1:863 195TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-8790
Mailing Address - Country:US
Mailing Address - Phone:620-200-4872
Mailing Address - Fax:620-223-1445
Practice Address - Street 1:13 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-1308
Practice Address - Country:US
Practice Address - Phone:620-200-4872
Practice Address - Fax:620-223-1445
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014016555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor