Provider Demographics
NPI:1952396640
Name:DAVIS, BRUCE ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:ALLEN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:154 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-1941
Mailing Address - Country:US
Mailing Address - Phone:715-743-3404
Mailing Address - Fax:715-743-4999
Practice Address - Street 1:154 E 5TH ST
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54656
Practice Address - Country:US
Practice Address - Phone:715-743-3404
Practice Address - Fax:715-743-4999
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38795300Medicaid
WIT51737Medicare UPIN