Provider Demographics
NPI:1912066200
Name:CROSS, TRAVIS ALAN (DC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ALAN
Last Name:CROSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:221 SHADOWLAWN RD SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4322
Mailing Address - Country:US
Mailing Address - Phone:770-394-1336
Mailing Address - Fax:770-394-1337
Practice Address - Street 1:855 MOUNT VERNON HWY NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4281
Practice Address - Country:US
Practice Address - Phone:770-394-1336
Practice Address - Fax:770-394-1337
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA6335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor