Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 038.013294 | IL |
NPI | 1174096796 |
---|---|
Provider Name | Dr. Connor Davis |
First Address | North Aurora, IL 60542-1914 |
Second Address | Aurora, IL 60502-9445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2019 |
Last Update Date | 07/01/2019 |