MEDICARE: JOHN TRAVIS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC6612	TX

General Provider Information

NPI Number	:	1275634677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN TRAVIS D.C.

Provider Business Mailing Address
First Line	:	8410 FOUNTAIN CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2387
Country	:	US
Telephone Number	:	210-308-6000
Fax Number	:	210-308-6006

Provider Business Practice Location Address
First Line	:	8410 FOUNTAIN CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2387
Country	:	US
Telephone Number	:	210-927-0000
Fax Number	:	210-308-6006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	01/03/2012

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