Provider Demographics
NPI:1164870911
Name:FLEMING, TRAVIS (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:FLEMING
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 1:2 EMERALD TER
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2317
Mailing Address - Country:US
Mailing Address - Phone:618-974-2700
Mailing Address - Fax:618-234-8092
Practice Address - Street 1:2 EMERALD TER
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2317
Practice Address - Country:US
Practice Address - Phone:618-974-2700
Practice Address - Fax:618-234-8092
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor