Healthcare Provider Details

I. General information

NPI: 1952396640
Provider Name (Legal Business Name): BRUCE ALLEN DAVIS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRUCE ALLEN DAVIS D.C.

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 E 5TH ST
NEILLSVILLE WI
54656
US

IV. Provider business mailing address

154 E 5TH ST
NEILLSVILLE WI
54456-1941
US

V. Phone/Fax

Practice location:
  • Phone: 715-743-3404
  • Fax: 715-743-4999
Mailing address:
  • Phone: 715-743-3404
  • Fax: 715-743-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2082
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: