Healthcare Provider Details

I. General information

NPI: 1396796785
Provider Name (Legal Business Name): ERIC MICHAEL DAVENPORT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80150 US HIGHWAY 111 SUITE C5
INDIO CA
92201-8359
US

IV. Provider business mailing address

PO BOX 7475
LA QUINTA CA
92248-7475
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-0435
  • Fax: 760-863-0436
Mailing address:
  • Phone: 562-485-8507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number31738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: