MEDICARE: DR. PATRICK R.E. DAVIS D.C.

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	111NR0400X	Rehabilitation Chiropractor	7836	TX
2	111NR0400X	Rehabilitation Chiropractor	1767	LA
3	111NR0400X	Rehabilitation Chiropractor	B01660	NV

General Provider Information

NPI Number	:	1316067846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK R.E. DAVIS D.C.

Provider Business Mailing Address
First Line	:	PO BOX 336543
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89033-6543
Country	:	US
Telephone Number	:	702-448-4566
Fax Number	:	725-605-3464

Provider Business Practice Location Address
First Line	:	3940 N MLK BLVD STE 107
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-6607
Country	:	US
Telephone Number	:	702-448-4566
Fax Number	:	725-605-3464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	02/28/2018

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