Provider Demographics
NPI:1154351609
Name:DAVIS, JONATHAN BLAIR (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BLAIR
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 1:16005 COMPRINT CIR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1318
Mailing Address - Country:US
Mailing Address - Phone:301-963-6700
Mailing Address - Fax:301-670-0306
Practice Address - Street 1:16005 COMPRINT CIR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1318
Practice Address - Country:US
Practice Address - Phone:301-963-6700
Practice Address - Fax:301-670-0306
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
013465Medicare UPIN