Healthcare Provider Details

I. General information

NPI: 1710016985
Provider Name (Legal Business Name): DR JILL DAVIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S ONEIDA ST SUITE 3
GREEN BAY WI
54304-2475
US

IV. Provider business mailing address

PO BOX 33106
GREEN BAY WI
54303-0101
US

V. Phone/Fax

Practice location:
  • Phone: 920-405-1010
  • Fax:
Mailing address:
  • Phone: 920-405-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1841-012
License Number StateWI

VIII. Authorized Official

Name: DR. JILL BETH DAVIES-KERN
Title or Position: OWNER
Credential: DC
Phone: 920-405-1010