Provider Demographics
NPI:1154716645
Name:DAVIS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:DAVIS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-860-9523
Mailing Address - Street 1:PO BOX 2447
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-2447
Mailing Address - Country:US
Mailing Address - Phone:803-957-2222
Mailing Address - Fax:803-957-2223
Practice Address - Street 1:518 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3668
Practice Address - Country:US
Practice Address - Phone:803-957-2222
Practice Address - Fax:803-957-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty