Provider Demographics
NPI:1780017772
Name:ROBERT W. TRAVEN D.C. P.A.
Entity Type:Organization
Organization Name:ROBERT W. TRAVEN D.C. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:TRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-453-6126
Mailing Address - Street 1:PO BOX 540610
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32954-0610
Mailing Address - Country:US
Mailing Address - Phone:321-453-6126
Mailing Address - Fax:321-453-8250
Practice Address - Street 1:950 N COURTENAY PKWY
Practice Address - Street 2:SUITE 11
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4501
Practice Address - Country:US
Practice Address - Phone:321-453-6126
Practice Address - Fax:321-453-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22293Medicare PIN
FLT85330Medicare UPIN