Provider Demographics
NPI:1104260330
Name:DOUGLAS F DAVIS CHIROPRACTIC CORP
Entity type:Organization
Organization Name:DOUGLAS F DAVIS CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-841-2840
Mailing Address - Street 1:2620 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2303
Mailing Address - Country:US
Mailing Address - Phone:818-841-2840
Mailing Address - Fax:818-841-2842
Practice Address - Street 1:2620 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2303
Practice Address - Country:US
Practice Address - Phone:818-841-2840
Practice Address - Fax:818-841-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245312891OtherUNSURE OF ISSUER BUT SUSPECT IT'S MEDICARE UPIN