Provider Demographics
NPI:1811938103
Name:DAVIS, GARY JR (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6305 CASTLE PL
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1905
Mailing Address - Country:US
Mailing Address - Phone:703-533-5555
Mailing Address - Fax:703-533-5596
Practice Address - Street 1:6305 CASTLE PL
Practice Address - Street 2:SUITE 1D
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1905
Practice Address - Country:US
Practice Address - Phone:703-533-5555
Practice Address - Fax:703-533-5596
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA490891Medicare ID - Type Unspecified
VAU85675Medicare UPIN