Provider Demographics
NPI:1063078525
Name:DAVIDSON, IRIS NOELANI (DC)
Entity type:Individual
Prefix:DR
First Name:IRIS
Middle Name:NOELANI
Last Name:DAVIDSON
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 1:72 BLUE SKY DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7146
Mailing Address - Country:US
Mailing Address - Phone:720-937-4342
Mailing Address - Fax:
Practice Address - Street 1:1137 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5135
Practice Address - Country:US
Practice Address - Phone:720-937-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor