MEDICARE: DR. DOUGLAS RAY 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	5926	UT

General Provider Information

NPI Number	:	1407039829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS RAY DAVIS D.C.

Provider Business Mailing Address
First Line	:	1770 E FORT UNION BLVD
Second Line	:	SUITE 101
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2876
Country	:	US
Telephone Number	:	801-942-0069
Fax Number	:	801-942-2809

Provider Business Practice Location Address
First Line	:	1770 E FORT UNION BLVD
Second Line	:	SUITE 101
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2876
Country	:	US
Telephone Number	:	801-942-0069
Fax Number	:	801-942-2809

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

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/19/2007

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