MEDICARE: MR. MITCHELL ELI 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	111N00000X	Chiropractor	006498	MO

General Provider Information

NPI Number	:	1396911350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MITCHELL ELI DAVIS D.C.

Provider Business Mailing Address
First Line	:	4144 LINDELL BLVD STE 319
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63108-2953
Country	:	US
Telephone Number	:	314-652-3000
Fax Number	:	314-652-3001

Provider Business Practice Location Address
First Line	:	4144 LINDELL BLVD STE 319
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63108-2953
Country	:	US
Telephone Number	:	314-652-3000
Fax Number	:	314-652-3001

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

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	10/26/2010

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