Provider Demographics
NPI:1992805576
Name:DAVIS, JOHN CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2322
Mailing Address - Country:US
Mailing Address - Phone:302-856-6466
Mailing Address - Fax:302-856-6618
Practice Address - Street 1:502 W MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2322
Practice Address - Country:US
Practice Address - Phone:302-856-6466
Practice Address - Fax:302-856-6618
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U10927Medicare UPIN
062418Medicare PIN