Healthcare Provider Details

I. General information

NPI: 1740699149
Provider Name (Legal Business Name): TRAVIS MARTIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FREMONT AVE STE 155
LOS ALTOS CA
94024-6049
US

IV. Provider business mailing address

38 N ALMADEN BLVD UNIT 907
SAN JOSE CA
95110-2748
US

V. Phone/Fax

Practice location:
  • Phone: 408-773-9165
  • Fax:
Mailing address:
  • Phone: 269-330-0821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number32993
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: