Provider Demographics
NPI:1740370923
Name:DAVIS, THOMAS ANDREW (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
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 1:2611 W MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-1600
Mailing Address - Country:US
Mailing Address - Phone:540-943-1611
Mailing Address - Fax:540-942-1721
Practice Address - Street 1:2611 W MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-1600
Practice Address - Country:US
Practice Address - Phone:540-943-1611
Practice Address - Fax:540-942-1721
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T43561Medicare UPIN