MEDICARE: DR. KRIS IVAN 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	8857	AZ

General Provider Information

NPI Number	:	1588692362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRIS IVAN DAVIS D.C.

Provider Business Mailing Address
First Line	:	1107 S GILBERT RD STE 111
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5233
Country	:	US
Telephone Number	:	480-506-0818
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 S GILBERT RD STE 111
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5233
Country	:	US
Telephone Number	:	480-506-0818
Fax Number	:	602-429-8507

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	02/02/2021

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