Provider Demographics
NPI:1669763132
Name:DAVIS, BONNIE (DC)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7374 W OHIO AVE
Mailing Address - Street 2:APT 301
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4989
Mailing Address - Country:US
Mailing Address - Phone:636-542-2360
Mailing Address - Fax:
Practice Address - Street 1:6950 E BELLEVIEW AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1618
Practice Address - Country:US
Practice Address - Phone:636-542-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor