Provider Demographics
NPI:1295881738
Name:DAVIS, JAMES MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
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 1:902 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2136
Mailing Address - Country:US
Mailing Address - Phone:805-489-2200
Mailing Address - Fax:805-489-1144
Practice Address - Street 1:902 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2136
Practice Address - Country:US
Practice Address - Phone:805-489-2200
Practice Address - Fax:805-489-1144
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12649OtherBOARD OF CHIROPRACTICE EXAMINERS LICENSE
CA12649OtherBOARD OF CHIROPRACTICE EXAMINERS LICENSE
CADC12649Medicare PIN