Provider Demographics
NPI:1871528711
Name:DAVIS, JOEL (DC)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S HIGHWAY 78 STE 104
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4046
Mailing Address - Country:US
Mailing Address - Phone:972-442-5800
Mailing Address - Fax:
Practice Address - Street 1:3701 BOSQUE BLVD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5035
Practice Address - Country:US
Practice Address - Phone:254-714-0054
Practice Address - Fax:254-714-0244
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor