Healthcare Provider Details

I. General information

NPI: 1366730335
Provider Name (Legal Business Name): DR JONATHAN B DAVIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16005 COMPRINT CIR
GAITHERSBURG MD
20877-1318
US

IV. Provider business mailing address

16005 COMPRINT CIR
GAITHERSBURG MD
20877-1318
US

V. Phone/Fax

Practice location:
  • Phone: 301-963-6700
  • Fax: 301-670-0306
Mailing address:
  • Phone: 301-963-6700
  • Fax: 301-670-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT L CARSON
Title or Position: ASSISTANT
Credential:
Phone: 240-252-4477