Provider Demographics
NPI:1699876847
Name:DAVIS, MARC C (DC)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:C
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 1:2415 SE 165TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4323
Mailing Address - Country:US
Mailing Address - Phone:360-823-2225
Mailing Address - Fax:360-823-2227
Practice Address - Street 1:2415 SE 165TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4323
Practice Address - Country:US
Practice Address - Phone:360-823-2225
Practice Address - Fax:360-823-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-2024358OtherTAX ID
WAU78707Medicare UPIN
WAGAB13434Medicare ID - Type Unspecified