Healthcare Provider Details

I. General information

NPI: 1114240843
Provider Name (Legal Business Name): JUSTIN ELIJAH DAVIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607W CHANDLER ST
ARLINGTON MN
55307-2127
US

IV. Provider business mailing address

1411 BENTON CREEK AVE
COLOGNE MN
55322-8010
US

V. Phone/Fax

Practice location:
  • Phone: 507-964-2850
  • Fax: 507-964-2333
Mailing address:
  • Phone: 952-913-5796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5308
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: