Provider Demographics
NPI:1972623890
Name:ERIC M. DAVIS
Entity Type:Organization
Organization Name:ERIC M. DAVIS
Other - Org Name:DAVIS FAMILY CHIROPRACTIC, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-683-4229
Mailing Address - Street 1:2856 FARRELL CRES
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1392
Mailing Address - Country:US
Mailing Address - Phone:270-683-4229
Mailing Address - Fax:270-688-0044
Practice Address - Street 1:2856 FARRELL CRES
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1392
Practice Address - Country:US
Practice Address - Phone:270-683-4229
Practice Address - Fax:270-688-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00290Medicare PIN
KYT92097Medicare UPIN