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General NPI Number Information
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NPI Number | 1306253786
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Entity Type | Organization
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Legal Business Name | DAVIS CHIROPRACTIC
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 772 FRONT STREET BOX 518
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City | CASSELTON
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State | ND
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Zip | 58012-0518
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Country | US
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Telephone | 701-347-4006
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Fax | 701-347-4247
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Provider Business Mailing Address
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Address Line | 722 FRONT ST PO BOX 518
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City | CASSELTON
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State | ND
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Zip | 58012-3302
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Country | US
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Telephone | 701-347-4006
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Fax | 701-347-4247
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Authorized Official
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Title or Position | OWNER
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Name | KEITH G DAVIS
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Credential | DC
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Telephone | 701-347-4006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 413
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License Number State | ND
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