Provider Demographics
NPI:1609991934
Name:NEWTON, TRAVIS D (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:D
Last Name:NEWTON
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 1:268 N LINCOLN AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7164
Mailing Address - Country:US
Mailing Address - Phone:951-735-3223
Mailing Address - Fax:951-735-3773
Practice Address - Street 1:268 N LINCOLN AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7164
Practice Address - Country:US
Practice Address - Phone:951-735-3223
Practice Address - Fax:951-735-3773
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28405Medicare PIN
U93472Medicare UPIN