=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609091560
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFF DAVIS D C PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2007
-----------------------------------------------------
Last Update Date | 10/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 W BLOOMINGDALE AVE
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-7401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-689-1883
-----------------------------------------------------
Fax | 813-684-9145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 W BLOOMINGDALE AVE
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-7401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. PAMELA DAVIES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-689-1883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHOOO3337
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------