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General NPI Number Information
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NPI Number | 1811182694
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Entity Type | Organization
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Legal Business Name | CLAYTON DIRK DAVIS
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 201 E MAIN ST
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City | WALNUT RIDGE
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State | AR
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Zip | 72476-2438
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Country | US
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Telephone | 870-886-8711
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Fax | 870-886-8712
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Provider Business Mailing Address
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Address Line | 201 E MAIN ST P.O.BOX 307
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City | WALNUT RIDGE
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State | AR
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Zip | 72476-2438
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Country | US
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Telephone | 870-886-8711
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Fax | 870-886-8712
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLAYTON DIRK DAVIS
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Credential | D.C.
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Telephone | 870-886-8711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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