Provider Demographics
NPI:1942493325
Name:DAVIS, HERBERT JORDAN
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:JORDAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:HERBERT
Other - Middle Name:JORDAN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:505 N SPENCE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4292
Mailing Address - Country:US
Mailing Address - Phone:919-751-0555
Mailing Address - Fax:919-751-3001
Practice Address - Street 1:505 N SPENCE AVE STE A
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4292
Practice Address - Country:US
Practice Address - Phone:919-751-0555
Practice Address - Fax:919-751-3001
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT64154Medicare UPIN
NC244048AMedicare PIN