Provider Demographics
NPI:1538197116
Name:DAVIS, KARL ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:ANDREW
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 1:105 FOUNTAINBROOK LN
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-6145
Mailing Address - Country:US
Mailing Address - Phone:803-667-6169
Mailing Address - Fax:
Practice Address - Street 1:417 S BUNCOMBE RD STE 4
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1209
Practice Address - Country:US
Practice Address - Phone:803-667-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2283111N00000X, 111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAETNA HMOOther2258774
SC0000233317802OtherUNITED HEALTH CARE
SC582438777OtherPREMIER HEALTH
SCMAMSIOther266323
SC582438777OtherBLUE CROSS/BLUE SHIELD SC
SC7025002OtherAETNA US HEALTH