Healthcare Provider Details

I. General information

NPI: 1265683031
Provider Name (Legal Business Name): TREVIS TYREE RAWLINSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W 11TH ST STE 102
TRACY CA
95376-3960
US

IV. Provider business mailing address

95 W 11TH ST STE 102
TRACY CA
95376-3960
US

V. Phone/Fax

Practice location:
  • Phone: 209-229-8756
  • Fax: 888-972-1896
Mailing address:
  • Phone: 209-229-8756
  • Fax: 888-972-1896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number31023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: