Healthcare Provider Details

I. General information

NPI: 1528587003
Provider Name (Legal Business Name): TRAVIS COMEAU DC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14120 BEACH BLVD STE 214
WESTMINSTER CA
92683-4454
US

IV. Provider business mailing address

4 INDUSTRIAL BLVD STE 200
PAOLI PA
19301-1605
US

V. Phone/Fax

Practice location:
  • Phone: 866-303-9355
  • Fax: 610-644-3162
Mailing address:
  • Phone: 610-644-3166
  • Fax: 610-644-3162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC011300
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number34965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: