Provider Demographics
NPI:1992561120
Name:DAVIS, AUSTIN RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:RICHARD
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 1:4339 SOUTHRIDGE MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2369
Mailing Address - Country:US
Mailing Address - Phone:314-422-2555
Mailing Address - Fax:
Practice Address - Street 1:1201 S BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1645
Practice Address - Country:US
Practice Address - Phone:314-644-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024000925111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation