Provider Demographics
NPI:1174513832
Name:DAVIS, JASON (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HIGHLAND SPRING RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3856
Mailing Address - Country:US
Mailing Address - Phone:207-782-3330
Mailing Address - Fax:207-786-9222
Practice Address - Street 1:16 HIGHLAND SPRING RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3856
Practice Address - Country:US
Practice Address - Phone:207-782-3330
Practice Address - Fax:207-786-9222
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U86869Medicare UPIN