Provider Demographics
NPI:1275634677
Name:TRAVIS, JOHN (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:TRAVIS
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 1:8410 FOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2387
Mailing Address - Country:US
Mailing Address - Phone:210-308-6000
Mailing Address - Fax:210-308-6006
Practice Address - Street 1:8410 FOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2387
Practice Address - Country:US
Practice Address - Phone:210-927-0000
Practice Address - Fax:210-308-6006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor