MEDICARE: DR. TRAVIS SCOTT ROSE 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	111NS0005X	Sports Physician Chiropractor	32600	CA

General Provider Information

NPI Number	:	1386087716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRAVIS SCOTT ROSE D.C.

Provider Business Mailing Address
First Line	:	2635 CAMINO DEL RIO S
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3726
Country	:	US
Telephone Number	:	619-818-4306
Fax Number	:	619-828-1030

Provider Business Practice Location Address
First Line	:	2635 CAMINO DEL RIO S
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3726
Country	:	US
Telephone Number	:	619-818-4306
Fax Number	:	619-828-1030

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

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	08/04/2022

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