Provider Demographics
NPI:1548633597
Name:TRAVIS, TIGE (DC)
Entity type:Individual
Prefix:DR
First Name:TIGE
Middle Name:
Last Name:TRAVIS
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 1:7800 N SOMMER ST
Mailing Address - Street 2:STE 203
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1934
Mailing Address - Country:US
Mailing Address - Phone:309-691-9767
Mailing Address - Fax:309-691-9457
Practice Address - Street 1:4001 PINE ST
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-5252
Practice Address - Country:US
Practice Address - Phone:309-691-9767
Practice Address - Fax:309-691-9457
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor