Healthcare Provider Details

I. General information

NPI: 1366959694
Provider Name (Legal Business Name): KELLSIE KAY-ANN DAVIS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 BEN FRANKLIN HWY E
DOUGLASSVILLE PA
19518-9547
US

IV. Provider business mailing address

990 BEN FRANKLIN HWY E
DOUGLASSVILLE PA
19518-9547
US

V. Phone/Fax

Practice location:
  • Phone: 610-385-1444
  • Fax: 610-385-1441
Mailing address:
  • Phone: 610-385-1444
  • Fax: 610-385-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC011320
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: