Provider Demographics
NPI:1851392013
Name:DAVIS, JASON E (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
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 1:21331 OLDE QUARRY LN
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7205
Mailing Address - Country:US
Mailing Address - Phone:352-348-9388
Mailing Address - Fax:
Practice Address - Street 1:21331 OLDE QUARRY LN
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-7205
Practice Address - Country:US
Practice Address - Phone:352-348-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06565111N00000X
FLCH 8681111N00000X
IA6565111N00000X
MN5433111N00000X
NC4945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61196OtherBCBS FL
FL61196OtherBCBS FL
FLU93863Medicare UPIN