Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 17458 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 17458 | CA |
N | 111NX0100X | Occupational Health | 17458 | CA |
NPI | 1659350924 |
---|---|
Provider Name | Dr. Charles G. Davis |
First Address | Glendora, CA 91741-5301 |
Second Address | Glendora, CA 91740-4609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 08/07/2007 |