Provider Demographics
NPI:1922024066
Name:DAVIDSON, KEVIN RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RAY
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 1:1905 VINE ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-3258
Mailing Address - Country:US
Mailing Address - Phone:785-628-8555
Mailing Address - Fax:
Practice Address - Street 1:1905 VINE ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-3258
Practice Address - Country:US
Practice Address - Phone:785-628-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS059988Medicare ID - Type UnspecifiedMEDICARE NUMBER