Provider Demographics
NPI:1417008368
Name:TRAVIS, GINA JANET (DC)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:JANET
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 E RTE 66
Mailing Address - Street 2:STE C
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740
Mailing Address - Country:US
Mailing Address - Phone:626-963-6332
Mailing Address - Fax:626-963-0262
Practice Address - Street 1:1435 E RTE 66
Practice Address - Street 2:STE C
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740
Practice Address - Country:US
Practice Address - Phone:626-963-6332
Practice Address - Fax:626-963-0262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U62431Medicare UPIN