Provider Demographics
NPI:1265683031
Name:RAWLINSON, TREVIS TYREE (DC)
Entity Type:Individual
Prefix:DR
First Name:TREVIS
Middle Name:TYREE
Last Name:RAWLINSON
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 1:95 W 11TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3960
Mailing Address - Country:US
Mailing Address - Phone:209-229-8756
Mailing Address - Fax:888-972-1896
Practice Address - Street 1:95 W 11TH ST STE 102
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3960
Practice Address - Country:US
Practice Address - Phone:209-229-8756
Practice Address - Fax:888-972-1896
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor