Active NPI
Charles Jay Davidson, DC
- Chiropractor
- Hercules, CA
National Provider Identifier
1386936441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 31506
- Practice address
- 2108 Drake LN
Hercules, CA 94547-5464 - Phone
- (510) 837-8441
- NPI assigned
- May 9, 2011
- Last updated
- May 9, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 31506 | CA | Primary |
Addresses
Primary practice location
2108 Drake LN
Hercules, CA 94547-5464
Mailing address
2108 Drake LN
Hercules, CA 94547-5464
Phone (510) 837-8441
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 111N00000X | Other | CA | NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304899200000",
"number": "1386936441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2108 DRAKE LN",
"city": "HERCULES",
"state": "CA",
"postal_code": "945475464",
"telephone_number": "510-837-8441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2108 DRAKE LN",
"city": "HERCULES",
"state": "CA",
"postal_code": "945475464",
"telephone_number": "510-837-8441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "CHARLES",
"middle_name": "JAY",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-05-09",
"last_updated": "2011-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "31506",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "111N00000X",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hercules, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.