Provider Demographics
NPI:1912962911
Name:DAVIS, DAVID GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GARY
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 1:158 DANBURY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-3227
Mailing Address - Country:US
Mailing Address - Phone:203-431-7779
Mailing Address - Fax:
Practice Address - Street 1:158 DANBURY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-3227
Practice Address - Country:US
Practice Address - Phone:203-431-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1912962911Medicare PIN