Provider Demographics
NPI:1861850620
Name:DAVIS, DWANE JR
Entity Type:Individual
Prefix:DR
First Name:DWANE
Middle Name:
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 GLENWOOD AVE APT 1003
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-5779
Mailing Address - Country:US
Mailing Address - Phone:832-556-3652
Mailing Address - Fax:
Practice Address - Street 1:1225 NORTH LOOP W STE 1010
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4722
Practice Address - Country:US
Practice Address - Phone:832-586-7183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor