Provider Demographics
NPI:1528376548
Name:MANN, TRAVIS MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:MATTHEW
Last Name:MANN
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 1:401 NORTHWEST HWY
Mailing Address - Street 2:#4336
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3669
Mailing Address - Country:US
Mailing Address - Phone:214-918-6383
Mailing Address - Fax:
Practice Address - Street 1:7200 STATE HIGHWAY 161
Practice Address - Street 2:SUITE 300
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4132
Practice Address - Country:US
Practice Address - Phone:972-393-8067
Practice Address - Fax:214-615-9734
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor