Provider Demographics
NPI:1710264460
Name:WILLIAM B DAVIS INC PS
Entity Type:Organization
Organization Name:WILLIAM B DAVIS INC PS
Other - Org Name:DAVIS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACS
Authorized Official - Phone:509-754-2461
Mailing Address - Street 1:1519 BASIN ST SW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-2135
Mailing Address - Country:US
Mailing Address - Phone:509-754-2461
Mailing Address - Fax:509-754-2462
Practice Address - Street 1:1519 BASIN ST SW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-2135
Practice Address - Country:US
Practice Address - Phone:509-754-2461
Practice Address - Fax:509-754-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000300337Medicare PIN