Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 6423 | TX |
NPI | 1760595235 |
---|---|
Provider Name | Dr. Michael Alan Davis |
First Address | Ft Worth, TX 76104-7234 |
Second Address | Ft Worth, TX 76104-7234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 05/05/2009 |