Provider Demographics
NPI:1194303057
Name:TRAVERSO, DAILIS (DC)
Entity type:Individual
Prefix:DR
First Name:DAILIS
Middle Name:
Last Name:TRAVERSO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 SHAWNEE TRL SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7316
Mailing Address - Country:US
Mailing Address - Phone:770-971-8115
Mailing Address - Fax:470-823-9752
Practice Address - Street 1:62 SHAWNEE TRL SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7316
Practice Address - Country:US
Practice Address - Phone:770-971-8115
Practice Address - Fax:470-823-9752
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor