Provider Demographics
NPI:1982651253
Name:DAVIS, RENSAY M (DC)
Entity Type:Individual
Prefix:
First Name:RENSAY
Middle Name:M
Last Name:DAVIS
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 1:2934 KEMP BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1017
Mailing Address - Country:US
Mailing Address - Phone:940-322-2400
Mailing Address - Fax:940-322-1930
Practice Address - Street 1:2934 KEMP BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1017
Practice Address - Country:US
Practice Address - Phone:940-322-2400
Practice Address - Fax:940-322-1930
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0017279-03Medicaid
TX8K9542OtherBLUE CROSS/BLUE SHIELD-TX
TXU46929Medicare UPIN
TX0017279-03Medicaid