Provider Demographics
NPI:1750447488
Name:DAVIS, JASON RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RAYMOND
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 1:3711 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2744
Mailing Address - Country:US
Mailing Address - Phone:919-477-0497
Mailing Address - Fax:919-477-3384
Practice Address - Street 1:3711 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2744
Practice Address - Country:US
Practice Address - Phone:919-477-0497
Practice Address - Fax:919-477-3384
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908219Medicaid
NC8908219Medicaid
NC2452441Medicare PIN