Provider Demographics
NPI:1528118304
Name:DAVIS, JULIE LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:W7218 ROSE LEN CT
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-8724
Mailing Address - Country:US
Mailing Address - Phone:715-536-3766
Mailing Address - Fax:
Practice Address - Street 1:706 S CENTER AVE
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-3405
Practice Address - Country:US
Practice Address - Phone:715-536-8111
Practice Address - Fax:715-536-3766
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2641-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor