Healthcare Provider Details

I. General information

NPI: 1215071188
Provider Name (Legal Business Name): DCC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 N COCHRAN AVE
CHARLOTTE MI
48813-1126
US

IV. Provider business mailing address

432 N COCHRAN AVE
CHARLOTTE MI
48813-1126
US

V. Phone/Fax

Practice location:
  • Phone: 517-543-2920
  • Fax: 517-543-1221
Mailing address:
  • Phone: 517-543-2920
  • Fax: 517-543-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007275
License Number StateMI

VIII. Authorized Official

Name: DR. KEVIN THOMAS DAVIS
Title or Position: OWNER
Credential: D.C.
Phone: 517-543-2920