Provider Demographics
NPI:1760519185
Name:DAVIS, ADAM MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MATTHEW
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 1:2124 GRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-8785
Mailing Address - Country:US
Mailing Address - Phone:440-576-2191
Mailing Address - Fax:
Practice Address - Street 1:1956 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6424
Practice Address - Country:US
Practice Address - Phone:440-992-0160
Practice Address - Fax:440-998-0121
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor