Provider Demographics
NPI:1043474083
Name:ROBERT F. TRAVIS JR. D. C. P. A.
Entity Type:Organization
Organization Name:ROBERT F. TRAVIS JR. D. C. P. A.
Other - Org Name:TRAVIS CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:TRAVIS, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:904-384-1240
Mailing Address - Street 1:4114 HERSCHEL STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210
Mailing Address - Country:US
Mailing Address - Phone:904-384-1240
Mailing Address - Fax:904-384-4912
Practice Address - Street 1:4114 HERSCHEL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2206
Practice Address - Country:US
Practice Address - Phone:904-384-1240
Practice Address - Fax:904-384-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0004648345OtherAETNA
GA70487OtherBLUE CROSS BLUE SHIELD
FLT84465Medicare UPIN