Provider Demographics
NPI:1952452906
Name:DAVIS, MARJORIE JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:JEAN
Last Name:DAVIS
Suffix:
Gender:F
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:PO BOX 318
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01090-0318
Mailing Address - Country:US
Mailing Address - Phone:413-788-8900
Mailing Address - Fax:413-788-8900
Practice Address - Street 1:900 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2659
Practice Address - Country:US
Practice Address - Phone:413-788-8900
Practice Address - Fax:413-788-8900
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36634OtherBLUE SHIELD
MAY36634OtherBLUE SHIELD
MA475035Medicare UPIN