Provider Demographics
NPI:1871598680
Name:DAVIS, KEVIN THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
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 1:432 N COCHRAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1126
Mailing Address - Country:US
Mailing Address - Phone:517-543-2920
Mailing Address - Fax:517-543-1221
Practice Address - Street 1:432 N COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1126
Practice Address - Country:US
Practice Address - Phone:517-543-2920
Practice Address - Fax:517-543-1221
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKD007275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5198793Medicaid
MI20-8640374OtherPPOM
MI950B311390OtherBLUE CARE NETWORK
MI1024457OtherMCLAREN
MI950B311390OtherBLUE CROSS BLUE SHIELD
P00458687OtherMEDICARE RAILROAD
MI200000008883OtherPHYSICIANS HEALTH PLAN
MI20-8640374OtherPPOM
MI950B311390OtherBLUE CROSS BLUE SHIELD