Provider Demographics
NPI:1528587003
Name:COMEAU, TRAVIS (DC, PA-C)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:COMEAU
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 INDUSTRIAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1605
Mailing Address - Country:US
Mailing Address - Phone:610-644-3166
Mailing Address - Fax:610-644-3162
Practice Address - Street 1:14120 BEACH BLVD STE 214
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4454
Practice Address - Country:US
Practice Address - Phone:866-303-9355
Practice Address - Fax:610-644-3162
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011300111N00000X
CA34965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor