Provider Demographics
NPI:1710951843
Name:DAVIS, JEFFREY
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5107 W 41ST STREET,
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-1463
Mailing Address - Country:US
Mailing Address - Phone:605-338-4200
Mailing Address - Fax:
Practice Address - Street 1:5107 W 41ST STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-1463
Practice Address - Country:US
Practice Address - Phone:605-338-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8637Medicare ID - Type Unspecified