Provider Demographics
NPI:1063561017
Name:DAVIS, KEVIN W (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
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 1:410 E FAIRMOUNT PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571
Mailing Address - Country:US
Mailing Address - Phone:281-881-5271
Mailing Address - Fax:281-605-5767
Practice Address - Street 1:410 E FAIRMOUNT PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571
Practice Address - Country:US
Practice Address - Phone:281-881-5271
Practice Address - Fax:281-605-5767
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC09151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R3192OtherBCBS
TX8R1729OtherBCBS
TX8W9091OtherBCBS
TX8W9101OtherBCBS
TX8W91111OtherBCBS
TX8R3192OtherBCBS