Provider Demographics
NPI:1801923768
Name:DAVISON, JAMES EDWARD (DC PC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:DAVISON
Suffix:
Gender:M
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3849 FAIRHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3760
Mailing Address - Country:US
Mailing Address - Phone:503-939-3462
Mailing Address - Fax:
Practice Address - Street 1:18747 SW MARTINAZZI AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-6808
Practice Address - Country:US
Practice Address - Phone:503-612-9981
Practice Address - Fax:503-885-9522
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR370356OtherACN GROUP ID
ORJD370356OtherASHN PROVIDER ID
OR082813001OtherREGENCE BCBS
ORJD370356OtherASHN PROVIDER ID