Provider Demographics
NPI:1881968444
Name:KENNETH Y. DAVIS D.C.P.C.
Entity type:Organization
Organization Name:KENNETH Y. DAVIS D.C.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:YALE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-744-7447
Mailing Address - Street 1:363 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3655
Mailing Address - Country:US
Mailing Address - Phone:973-744-7447
Mailing Address - Fax:973-744-7449
Practice Address - Street 1:363 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 2E
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3655
Practice Address - Country:US
Practice Address - Phone:973-744-7447
Practice Address - Fax:973-744-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00160000111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty