Provider Demographics
NPI:1487930947
Name:DAVIS, KRISTIE L (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 W TYLER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4225
Mailing Address - Country:US
Mailing Address - Phone:870-394-9197
Mailing Address - Fax:
Practice Address - Street 1:318 W TYLER AVE STE A
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4225
Practice Address - Country:US
Practice Address - Phone:870-394-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012048111N00000X
AR16185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209275002Medicare UPIN