Provider Demographics
NPI:1740301886
Name:DAVIS, KENNETH WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:WILLIAM
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 1:381 PALM COAST PKWY SW
Mailing Address - Street 2:UNIT 2
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4781
Mailing Address - Country:US
Mailing Address - Phone:386-264-6800
Mailing Address - Fax:386-264-6802
Practice Address - Street 1:381 PALM COAST PKWY SW
Practice Address - Street 2:UNIT 2
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4781
Practice Address - Country:US
Practice Address - Phone:386-264-6800
Practice Address - Fax:386-264-6802
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381133600Medicaid
FL381133600Medicaid