Provider Demographics
NPI:1902978323
Name:DAVIS, JAMES K (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
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:P.O. BOX 224
Mailing Address - Street 2:164 NORTH MAIN STREET
Mailing Address - City:VICTOR
Mailing Address - State:ID
Mailing Address - Zip Code:83455
Mailing Address - Country:US
Mailing Address - Phone:208-787-1199
Mailing Address - Fax:
Practice Address - Street 1:164 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:ID
Practice Address - Zip Code:83455
Practice Address - Country:US
Practice Address - Phone:208-787-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1375431Medicare ID - Type Unspecified