Provider Demographics
NPI:1972603603
Name:DAVIS, TIM A (DC)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:A
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 1:3751 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103
Mailing Address - Country:US
Mailing Address - Phone:817-536-1329
Mailing Address - Fax:817-536-2093
Practice Address - Street 1:3751 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103
Practice Address - Country:US
Practice Address - Phone:817-536-1329
Practice Address - Fax:817-536-2093
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
602025Medicare ID - Type Unspecified