Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC894 | NM |
NPI | 1073654455 |
---|---|
Provider Name | Dr. Brett Davis |
First Address | Albuquerque, NM 87108-4726 |
Second Address | Albuquerque, NM 87108-4726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
894 | LICENSE NUMBER (01) | NM |