Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4445 | NC |
N | 111N00000X | Chiropractor | CH 6473 | FL |
NPI | 1003987330 |
---|---|
Provider Name | Dr. William Gordon Davis SR. |
First Address | Titusville, FL 32796-2975 |
Second Address | Concord, NC 28027-5930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 16/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U46434 | (02) |