Individual
SAM XAVIER FUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1536 W CENTRAL PARK AVE, DAVENPORT, IA 52804-1741
(660) 342-6871
(660) 342-6871
Mailing address
1536 W CENTRAL PARK AVE, DAVENPORT, IA 52804-1741
(660) 342-6871
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/12/2017
Last updated
10/12/2017
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