=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669576302
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVIS CHIROPRACTIC SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2006
-----------------------------------------------------
Last Update Date | 03/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 154 E. 5TH STREET
-----------------------------------------------------
City | NEILLSVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54456-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-743-3404
-----------------------------------------------------
Fax | 715-743-4999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 154 E 5TH ST
-----------------------------------------------------
City | NEILLSVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54456-1941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-743-3404
-----------------------------------------------------
Fax | 715-743-4999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRUCE ALLEN DAVIS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 715-743-3404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2082
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------