Healthcare Provider Details

I. General information

NPI: 1518301563
Provider Name (Legal Business Name): RYAN KEITH DAVIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MAIN ST
WAYLAND MA
01778-4923
US

IV. Provider business mailing address

115 MAIN ST
WAYLAND MA
01778-4923
US

V. Phone/Fax

Practice location:
  • Phone: 508-545-2254
  • Fax: 508-545-1987
Mailing address:
  • Phone: 508-545-2254
  • Fax: 508-545-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3417
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: