Provider Demographics
NPI:1124136528
Name:DAVIS CHIROPRACTIC INC
Entity type:Organization
Organization Name:DAVIS CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-489-1477
Mailing Address - Street 1:880 OAK PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1821
Mailing Address - Country:US
Mailing Address - Phone:805-489-1477
Mailing Address - Fax:805-489-2356
Practice Address - Street 1:880 OAK PARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1821
Practice Address - Country:US
Practice Address - Phone:805-489-1477
Practice Address - Fax:805-489-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASAT 2025OtherBOARD OF CHIROPRACTIC EXAMINERS- SATELLITE OFFICE CERTIFICATE
CA56026OtherCITY OF ARROYO GRANDE BUSINESS LICENSE
CAC0977031OtherSECRETARY OF STATE-CA CORPORATION NUMBER
CA363OtherBOARD OF CHIROPRACTIC EXAMINERS- CORPORATION CERTIFICATE NUMBER