Provider Demographics
NPI:1245267996
Name:DAVIS, MICHAEL A (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
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 1:1616 N LITCHFIELD RD STE 250
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1298
Mailing Address - Country:US
Mailing Address - Phone:623-535-8661
Mailing Address - Fax:623-535-8662
Practice Address - Street 1:1616 N LITCHFIELD RD STE 250
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1298
Practice Address - Country:US
Practice Address - Phone:623-535-8661
Practice Address - Fax:623-535-8662
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ78452Medicare ID - Type Unspecified
AZU88680Medicare UPIN