MEDICARE: NW MAIN CHIROPRACTIC, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	12144	TX
2	225100000X	Physical Therapist	1044915	TX
3	111N00000X	Chiropractor	8285	TX

General Provider Information

NPI Number	:	1093909905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NW MAIN CHIROPRACTIC, P.A.

Provider Business Mailing Address
First Line	:	109 NW MAIN ST
Second Line	:
City	:	ENNIS
State	:	TX
Zip	:	75119-4053
Country	:	US
Telephone Number	:	972-875-9377
Fax Number	:	972-875-4325

Provider Business Practice Location Address
First Line	:	109 NW MAIN ST
Second Line	:
City	:	ENNIS
State	:	TX
Zip	:	75119-4053
Country	:	US
Telephone Number	:	972-875-9377
Fax Number	:	972-875-4325

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM C. DAVIS
Credential	:	DC
Telephone Number	:	972-875-9377

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	11/06/2021

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Practice Location Address:

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Directions to “NW MAIN CHIROPRACTIC, P.A. ” Practice Location

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