Doctor Name: | GREG W DAVIDOVICH |
NPI Number: | 1649218777 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 6658 |
Business Practice Address: | 680 N Carroll Ave 120 Southlake, TX - 760926411 |
Business Phone Number: | 8174219111 |
Business Fax Number: | |
Mailing Address: | Po Box 92248, SOUTHLAKE |
State: | TX |
Postal Code: | 760920103 |
Phone Number: | 8174219111 |
Fax Number: | |
NPI Enumeration Date: | 06/02/2006 |
NPI Last Update Date: | 09/19/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 6658 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |