Provider Demographics
NPI:1831339977
Name:DAVIS, SAMUEL (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
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 1:185 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10537-1344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 LAKE DR
Practice Address - Street 2:
Practice Address - City:LAKE PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10537-1344
Practice Address - Country:US
Practice Address - Phone:845-284-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005318-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor