Provider Demographics
NPI:1750481024
Name:DAVIS, JON MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MICHAEL
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 1:71 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1040
Mailing Address - Country:US
Mailing Address - Phone:320-259-9099
Mailing Address - Fax:320-529-9199
Practice Address - Street 1:71 10TH AVE S
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1040
Practice Address - Country:US
Practice Address - Phone:320-259-9099
Practice Address - Fax:320-529-9199
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor