1104260330 NPI number — DOUGLAS F DAVIS CHIROPRACTIC CORP

Table of content: (NPI 1104260330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104260330 NPI number — DOUGLAS F DAVIS CHIROPRACTIC CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS F DAVIS CHIROPRACTIC CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1104260330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 W BURBANK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91505-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-841-2840
Provider Business Mailing Address Fax Number:
818-841-2842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 W BURBANK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91505-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-841-2840
Provider Business Practice Location Address Fax Number:
818-841-2842
Provider Enumeration Date:
04/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
F
Authorized Official Title or Position:
BUSINESS OWNER AND PRESIDENT
Authorized Official Telephone Number:
818-841-2840

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC25558 , 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)

  • Identifier: 1245312891 . This is a "UNSURE OF ISSUER BUT SUSPECT IT'S MEDICARE UPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com