1396796785 NPI number — DR. ERIC MICHAEL DAVENPORT D.C.

Table of content: DR. ERIC MICHAEL DAVENPORT D.C. (NPI 1396796785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396796785 NPI number — DR. ERIC MICHAEL DAVENPORT D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVENPORT
Provider First Name:
ERIC
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396796785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7475
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA QUINTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92248-7475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-485-8507
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80150 US HIGHWAY 111
Provider Second Line Business Practice Location Address:
SUITE C5
Provider Business Practice Location Address City Name:
INDIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92201-8359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-863-0435
Provider Business Practice Location Address Fax Number:
760-863-0436
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  31738 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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