Provider Demographics
NPI:1548284367
Name:TRAVEN, ROBERT WALTER (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WALTER
Last Name:TRAVEN
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:PO BOX 540610
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32954-0610
Mailing Address - Country:US
Mailing Address - Phone:321-453-6126
Mailing Address - Fax:321-453-8250
Practice Address - Street 1:650 S COURTENAY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4977
Practice Address - Country:US
Practice Address - Phone:321-394-2660
Practice Address - Fax:321-394-2669
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22293Medicare ID - Type Unspecified
FLT85330Medicare UPIN