Provider Demographics
NPI:1144473208
Name:DAVIS, CHRISTOPHER JACKSON (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JACKSON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 LOUCKS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-1752
Mailing Address - Country:US
Mailing Address - Phone:717-650-1398
Mailing Address - Fax:717-650-2177
Practice Address - Street 1:320 LOUCKS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1752
Practice Address - Country:US
Practice Address - Phone:717-650-1398
Practice Address - Fax:717-650-2177
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007771-L207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013950600010Medicaid