MEDICARE: DR. MARJORIE JEAN 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	2308	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y36634	OTHER	MA	BLUE SHIELD

General Provider Information

NPI Number	:	1952452906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARJORIE JEAN DAVIS D.C.

Provider Business Mailing Address
First Line	:	PO BOX 318
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01090-0318
Country	:	US
Telephone Number	:	413-788-8900
Fax Number	:	413-788-8900

Provider Business Practice Location Address
First Line	:	900 ELM ST
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-2659
Country	:	US
Telephone Number	:	413-788-8900
Fax Number	:	413-788-8900

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/09/2007

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