Provider Demographics
NPI:1659583466
Name:TRAVIS, RHETT (DC)
Entity Type:Individual
Prefix:DR
First Name:RHETT
Middle Name:
Last Name:TRAVIS
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 1:4633 BRAMBLETON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3410
Mailing Address - Country:US
Mailing Address - Phone:540-400-7733
Mailing Address - Fax:
Practice Address - Street 1:4633 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3410
Practice Address - Country:US
Practice Address - Phone:540-400-7733
Practice Address - Fax:540-904-6009
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor