Provider Demographics
NPI:1710024047
Name:TRAVIS, MICHAEL RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RYAN
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 1:55 LARK LN
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-8912
Mailing Address - Country:US
Mailing Address - Phone:610-944-0673
Mailing Address - Fax:
Practice Address - Street 1:3864 COURTNEY ST
Practice Address - Street 2:SUITE 140
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8987
Practice Address - Country:US
Practice Address - Phone:610-691-4444
Practice Address - Fax:610-691-4455
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009744111N00000X
PAAJ009550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor