Provider Demographics
NPI:1841546090
Name:GREGG D. DAVIS D.C.,P.C.
Entity type:Organization
Organization Name:GREGG D. DAVIS D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-220-4567
Mailing Address - Street 1:6268 S KINGS RANCH RD
Mailing Address - Street 2:7-A
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-7353
Mailing Address - Country:US
Mailing Address - Phone:480-220-4567
Mailing Address - Fax:
Practice Address - Street 1:6268 S KINGS RANCH RD
Practice Address - Street 2:7-A
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-7353
Practice Address - Country:US
Practice Address - Phone:480-220-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty