Provider Demographics
NPI:1538264825
Name:ROBERTSON, TRAVIS JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:JAMES
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1434
Mailing Address - Country:US
Mailing Address - Phone:319-396-2300
Mailing Address - Fax:319-396-2300
Practice Address - Street 1:3221 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1434
Practice Address - Country:US
Practice Address - Phone:319-396-2300
Practice Address - Fax:319-396-2300
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAV08823Medicare UPIN
IAI17321Medicare ID - Type UnspecifiedGROUP NUMBER IS I7939