Provider Demographics
NPI:1710988548
Name:DAVIS, RODNEY C (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:C
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 1:2061 E 9400 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-3128
Mailing Address - Country:US
Mailing Address - Phone:801-733-0550
Mailing Address - Fax:801-733-0075
Practice Address - Street 1:2061 E 9400 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-3128
Practice Address - Country:US
Practice Address - Phone:801-733-0550
Practice Address - Fax:801-733-0075
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT158871-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT786080Medicaid
UT786080Medicaid