Provider Demographics
NPI:1144402322
Name:DAVIS, TRAVIS W (DC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 W 22ND ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1983
Mailing Address - Country:US
Mailing Address - Phone:757-627-2222
Mailing Address - Fax:757-627-2999
Practice Address - Street 1:738 W 22ND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1983
Practice Address - Country:US
Practice Address - Phone:757-627-2222
Practice Address - Fax:757-627-2999
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor