Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 953 | OH |
N | 111NS0005X | Chiropractic Sports Physician | 953 | OH |
NPI | 1265508592 |
---|---|
Provider Name | Dr. Michael A Davis |
First Address | Columbus, OH 43228-1714 |
Second Address | Columbus, OH 43228-1714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 09/11/2011 |