Provider Demographics
NPI:1881606226
Name:EHLERS, TRAVIS COLIN (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:COLIN
Last Name:EHLERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8793 LIGHTWAVE AVE
Mailing Address - Street 2:APT. 428
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-5000
Mailing Address - Country:US
Mailing Address - Phone:612-327-0809
Mailing Address - Fax:
Practice Address - Street 1:5471 KEARNY VILLA RD
Practice Address - Street 2:STE. 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1151
Practice Address - Country:US
Practice Address - Phone:858-571-0606
Practice Address - Fax:858-571-1933
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC30194AMedicare UPIN