Provider Demographics
NPI:1578949137
Name:DEWITT, TRAVIS (DC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:DEWITT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:TRAVIS
Other - Middle Name:
Other - Last Name:BEALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4245 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3169
Mailing Address - Country:US
Mailing Address - Phone:319-329-5946
Mailing Address - Fax:
Practice Address - Street 1:4245 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3169
Practice Address - Country:US
Practice Address - Phone:319-329-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor