MEDICARE: DR. JOHN ALAN DAVENPORT DC

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	CH0006642	FL

General Provider Information

NPI Number	:	1356311260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALAN DAVENPORT DC

Provider Business Mailing Address
First Line	:	2710 S 3RD ST
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250
Country	:	US
Telephone Number	:	904-246-1512
Fax Number	:	904-246-8105

Provider Business Practice Location Address
First Line	:	2710 S 3RD ST
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250
Country	:	US
Telephone Number	:	904-246-1512
Fax Number	:	904-246-8105

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JOHN ALAN DAVENPORT DC” Practice Location

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