Greg C. Davis, D.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

4259 Issued in AZ

Practice address

2240 McCulloch Blvd N
Ste C
Lake Havasu City, AZ 86403-6904

Phone

(928) 453-2225

Fax

(928) 453-4791

NPI assigned

Aug 28, 2006

Last updated

Sep 12, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

ChiropracticAlso: Sports Medicine

Education

Los Angeles College of Chiropractic, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Made 4 Movement PLLC

  • Chiropractor
  • Lake Havasu City, AZ
  • NPI 1346937026
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505174400000",
    "number": "1336257435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 MCCULLOCH BLVD N",
            "address_2": "STE C",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036904",
            "telephone_number": "928-453-2225",
            "fax_number": "928-453-4791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 MCCULLOCH BLVD N",
            "address_2": "STE C",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036904",
            "telephone_number": "928-453-2225",
            "fax_number": "928-453-4791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "GREG",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2017-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "AZ",
            "license": "4259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER",
            "identifier": "0243840",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ali Noori Daham, DDS
• Cheryl Ann Dameron, PTA
• Dana Balderrama MD PC
• Maame Ampomah Dankwah, MD, MPH
• Rachelle Renee Davidhizar, MSW
• Michele L Davis, MSW
• Kyle Denman, PAC
• Dental Specialists of NW Arizona
• Desert Health Transport Inc.
• Desert Hills Fire District

• Sports Physician Chiropractor in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Sports Physician Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.