Individual
DR. RUSSELL KELSO DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
318 E. MAIN ST., HAVELOCK, NC 28532-2214
(252) 444-3377
(252) 444-3529
Mailing address
318 E. MAIN ST., NAVAL HOSPITAL, HAVELOCK, NC 28532-2214
(252) 444-3377
(252) 444-3529
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
2801
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0844V
BCBS PROVIDER #
NC
01
—
616120
ACN IDENTIFICATION #
NC
01
—
7167352
AETNA PROVIDER #
NC
05
—
890844V
—
NC
Enumeration date
05/24/2005
Last updated
05/17/2016
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