Individual
GREG W DAVIDOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
680 N CARROLL AVE, 120, SOUTHLAKE, TX 76092-6411
(817) 421-9111
Mailing address
PO BOX 92248, SOUTHLAKE, TX 76092-0103
(817) 421-9111
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6658
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8U7605
BCBS
TX
Enumeration date
06/02/2006
Last updated
09/19/2007
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