Provider Demographics
NPI:1568556603
Name:TRAVIS, ROBERT F JR (D C)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:TRAVIS
Suffix:JR
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 HERSCHEL STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2206
Mailing Address - Country:US
Mailing Address - Phone:904-384-1240
Mailing Address - Fax:904-384-4912
Practice Address - Street 1:4114 HERSCHEL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2206
Practice Address - Country:US
Practice Address - Phone:904-384-1240
Practice Address - Fax:904-384-4912
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004525111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84465Medicare UPIN
FL70487Medicare ID - Type UnspecifiedPROVIDER #