MEDICARE: KWD ENTERPRISES, 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	:	1801352406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KWD ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	1107 S GILBERT RD STE 111
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5233
Country	:	US
Telephone Number	:	480-506-0818
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 S GILBERT RD STE 111
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5233
Country	:	US
Telephone Number	:	480-506-0818
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. KRIS DAVIS
Credential	:
Telephone Number	:	480-506-0818

Provider Enumeration Date	:	02/19/2019
Last Update Date	:	02/02/2021

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Directions to “KWD ENTERPRISES, LLC ” Practice Location

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