Provider Demographics
NPI:1366771677
Name:DAVIS, KENNETH CASEY (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CASEY
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:P.O. BOX 483
Mailing Address - Street 2:
Mailing Address - City:MT. VIEW
Mailing Address - State:WY
Mailing Address - Zip Code:82939-0483
Mailing Address - Country:US
Mailing Address - Phone:307-444-7773
Mailing Address - Fax:
Practice Address - Street 1:1101 MAIN STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930
Practice Address - Country:US
Practice Address - Phone:307-444-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor