Provider Demographics
NPI:1932135217
Name:TRAVIS, BONNIE E (DC)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:E
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65134 CLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-1486
Mailing Address - Country:US
Mailing Address - Phone:760-671-6801
Mailing Address - Fax:
Practice Address - Street 1:65134 CLIFF CIR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-1486
Practice Address - Country:US
Practice Address - Phone:760-671-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0165630Medicare PIN
CATO6184Medicare UPIN