Provider Demographics
NPI:1548681596
Name:DUNLAP, TRAVIS (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:DUNLAP
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 1:1024 BRANDON WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-9778
Mailing Address - Country:US
Mailing Address - Phone:619-606-3000
Mailing Address - Fax:
Practice Address - Street 1:9610 GRANITE RIDGE DRIVE SUITE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-573-0550
Practice Address - Fax:858-573-0551
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor