=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619049673
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD T DAVIES DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 640 RIDGE ROAD
-----------------------------------------------------
City | MONOUTH JUNCTION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-329-6676
-----------------------------------------------------
Fax | 732-329-6643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 640 RIDGE ROAD
-----------------------------------------------------
City | MONOUTH JUNCTION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-329-6676
-----------------------------------------------------
Fax | 732-329-6643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | MC01716
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------