Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 7979 | TX |
NPI | 1003024340 |
---|---|
Provider Name | Dr. Chris Blake Davis |
First Address | Spring, TX 77388-5043 |
Second Address | Conroe, TX 77304-2042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 12/06/2013 |