Provider Demographics
NPI:1790767754
Name:DAVIS, RICHARD E (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
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 1:100 S DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-1208
Mailing Address - Country:US
Mailing Address - Phone:724-662-4299
Mailing Address - Fax:724-662-5800
Practice Address - Street 1:100 S DIAMOND ST
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-1208
Practice Address - Country:US
Practice Address - Phone:724-662-4299
Practice Address - Fax:724-662-5800
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001650L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006381090001Medicaid
PAT28781Medicare UPIN
PA0006381090001Medicaid