Provider Demographics
NPI:1174554265
Name:DAVIS CLINIC OF CHIROPRACTIC, INC
Entity type:Organization
Organization Name:DAVIS CLINIC OF CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-430-2121
Mailing Address - Street 1:1585 SANTA BARBARA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6820
Mailing Address - Country:US
Mailing Address - Phone:352-430-2121
Mailing Address - Fax:352-430-2114
Practice Address - Street 1:1585 SANTA BARBARA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6820
Practice Address - Country:US
Practice Address - Phone:352-430-2121
Practice Address - Fax:352-430-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty