Provider Demographics
NPI:1619342888
Name:GAGE, TRAVIS ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:ALAN
Last Name:GAGE
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 1:301 MAPLE AVE W STE 515
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4302
Mailing Address - Country:US
Mailing Address - Phone:703-319-1212
Mailing Address - Fax:037-319-1215
Practice Address - Street 1:301 MAPLE AVE W STE 515
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4302
Practice Address - Country:US
Practice Address - Phone:703-319-1212
Practice Address - Fax:703-319-1215
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor