MEDICARE: PAUL DAVIS

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	6103882-1202	UT

General Provider Information

NPI Number	:	1871854497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL DAVIS

Provider Business Mailing Address
First Line	:	9782 PHEASANT DR
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-9126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2061 E 9400 S
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-3128
Country	:	US
Telephone Number	:	801-733-0075
Fax Number	:

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

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	05/30/2012

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Directions to “ PAUL DAVIS ” Practice Location

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