Provider Demographics
NPI:1952453375
Name:DAVIS, GINA D (DC)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 AIRPORT CENTER DRIVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264
Mailing Address - Country:US
Mailing Address - Phone:760-320-1956
Mailing Address - Fax:760-320-4648
Practice Address - Street 1:4050 AIRPORT CENTER DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264
Practice Address - Country:US
Practice Address - Phone:760-320-1956
Practice Address - Fax:760-320-4648
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22253111N00000X
CADC22253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0222530Medicare PIN
CADC0222530Medicare ID - Type Unspecified
CA47-0865910Medicare UPIN