MEDICARE: DR. BRIAN R 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	3578	SC
2	111NN0400X	Neurology Chiropractor	3578	SC
3	111NN1001X	Nutrition Chiropractor	3578	SC

General Provider Information

NPI Number	:	1851680094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN R DAVIS D.C.

Provider Business Mailing Address
First Line	:	1622 E NORTH ST
Second Line	:	STE 10
City	:	GREENVILLE
State	:	SC
Zip	:	29607-1329
Country	:	US
Telephone Number	:	864-406-3300
Fax Number	:	877-391-1231

Provider Business Practice Location Address
First Line	:	1622 E NORTH ST
Second Line	:	STE 10
City	:	GREENVILLE
State	:	SC
Zip	:	29607-1329
Country	:	US
Telephone Number	:	864-406-3300
Fax Number	:	877-391-1231

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

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	03/08/2013

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