Provider Demographics
NPI:1851680094
Name:DAVIS, BRIAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
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 1:1622 E NORTH ST
Mailing Address - Street 2:STE 10
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1329
Mailing Address - Country:US
Mailing Address - Phone:864-406-3300
Mailing Address - Fax:877-391-1231
Practice Address - Street 1:1622 E NORTH ST
Practice Address - Street 2:STE 10
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1329
Practice Address - Country:US
Practice Address - Phone:864-406-3300
Practice Address - Fax:877-391-1231
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3578111N00000X, 111NN0400X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition