Provider Demographics
NPI:1073180394
Name:ZINNER, TRAVIS CLARK (DACM)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:CLARK
Last Name:ZINNER
Suffix:
Gender:M
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 TOWNE CENTRE DR UNIT 75
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3045
Mailing Address - Country:US
Mailing Address - Phone:303-808-7552
Mailing Address - Fax:
Practice Address - Street 1:9310 TOWNE CENTRE DR UNIT 75
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3045
Practice Address - Country:US
Practice Address - Phone:303-808-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19038171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty