MEDICARE: DR. IAN DAVIS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH34448	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0204424	OTHER	WA	DEPARTMENT OF LABOR AND I

General Provider Information

NPI Number	:	1154359776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IAN DAVIS D.C.

Provider Business Mailing Address
First Line	:	10030 15TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-3728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10030 15TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-3728
Country	:	US
Telephone Number	:	206-763-7464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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