Provider Demographics
NPI:1831255736
Name:DAVIS, GARY B (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
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 1:716 E. 4500 SOUTH
Mailing Address - Street 2:STE. N250
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-262-8400
Mailing Address - Fax:801-262-5570
Practice Address - Street 1:716 E. 4500 SOUTH
Practice Address - Street 2:STE. N250
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-262-8400
Practice Address - Fax:801-262-5570
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176215-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU54066Medicare UPIN
UT000056083Medicare ID - Type Unspecified