Provider Demographics
NPI:1801962089
Name:DAVIS, JEFFREY LYLE (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LYLE
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 1:409 W BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7401
Mailing Address - Country:US
Mailing Address - Phone:813-689-1883
Mailing Address - Fax:813-684-9145
Practice Address - Street 1:409 W BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7401
Practice Address - Country:US
Practice Address - Phone:813-689-1883
Practice Address - Fax:813-684-9145
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-3156437OtherEIN
FL59-3156437OtherEIN
FL88443Medicare ID - Type Unspecified