MEDICARE: DAVCOALT, LLC

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

General Provider Information

NPI Number	:	1437118841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVCOALT, LLC

Provider Business Mailing Address
First Line	:	601 N MOUNTAIN RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-2371
Country	:	US
Telephone Number	:	717-652-8940
Fax Number	:	717-652-8945

Provider Business Practice Location Address
First Line	:	601 N MOUNTAIN RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-2371
Country	:	US
Telephone Number	:	717-652-8940
Fax Number	:	717-652-8945

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. ERNEST L. DAVIS
Credential	:	D. C.
Telephone Number	:	717-652-8940

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/12/2010

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