Provider Demographics
NPI:1306081658
Name:DAVIS, DONI BETH (DC)
Entity type:Individual
Prefix:DR
First Name:DONI
Middle Name:BETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DONI
Other - Middle Name:BETH
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3720 72ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144
Mailing Address - Country:US
Mailing Address - Phone:262-764-9301
Mailing Address - Fax:262-764-9303
Practice Address - Street 1:3720 - 72ND AVENUE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144
Practice Address - Country:US
Practice Address - Phone:262-764-9301
Practice Address - Fax:262-764-9303
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4455-012111N00000X
WI4455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor