Provider Demographics
NPI:1558390609
Name:PTOMEY, TRAVIS (DC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:PTOMEY
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 1:3775 IRIS AVE
Mailing Address - Street 2:STE 1A
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3775 IRIS AVE
Practice Address - Street 2:STE 1A
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2043
Practice Address - Country:US
Practice Address - Phone:303-440-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU84862Medicare UPIN