Provider Demographics
NPI:1962475368
Name:DAVIS, RICHARD KEARNS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KEARNS
Last Name:DAVIS
Suffix:JR
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 1:408 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-2704
Mailing Address - Country:US
Mailing Address - Phone:828-464-7791
Mailing Address - Fax:828-465-4062
Practice Address - Street 1:408 1ST AVE S
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2704
Practice Address - Country:US
Practice Address - Phone:828-464-7791
Practice Address - Fax:828-465-4062
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1387111N00000X
SC2461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908341Medicaid
08341OtherBLUE CROSS
T64442Medicare UPIN
NC8908341Medicaid