Provider Demographics
NPI:1912551292
Name:DAVIS, AUSTIN BAKER
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:BAKER
Last Name:DAVIS
Suffix:
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 1:859 HIGHWAY 26 W
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-7467
Mailing Address - Country:US
Mailing Address - Phone:601-795-0211
Mailing Address - Fax:
Practice Address - Street 1:859 HIGHWAY 26 W
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-7467
Practice Address - Country:US
Practice Address - Phone:601-795-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor