Provider Demographics
NPI:1871863803
Name:DAVIDSON, THEODORE EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:EDWARD
Last Name:DAVIDSON
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 1:5015 S WESTERN AVE
Mailing Address - Street 2:STE. 160
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2642
Mailing Address - Country:US
Mailing Address - Phone:605-271-8160
Mailing Address - Fax:605-271-8162
Practice Address - Street 1:5015 S WESTERN AVE
Practice Address - Street 2:STE. 160
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2642
Practice Address - Country:US
Practice Address - Phone:605-271-8160
Practice Address - Fax:605-271-8162
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor