Provider Demographics
NPI:1669552170
Name:DAVIS, ARDEE FRIZZELL (DC)
Entity type:Individual
Prefix:DR
First Name:ARDEE
Middle Name:FRIZZELL
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 1:477 HAMILTON ST
Mailing Address - Street 2:STE 1
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:00873-2600
Mailing Address - Country:US
Mailing Address - Phone:732-296-1906
Mailing Address - Fax:732-296-1908
Practice Address - Street 1:477 HAMILTON ST
Practice Address - Street 2:STE 1
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:00873-2600
Practice Address - Country:US
Practice Address - Phone:732-296-1906
Practice Address - Fax:732-296-1908
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC004702111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA814742Medicare ID - Type Unspecified
U59498Medicare UPIN