Provider Demographics
NPI:1386087716
Name:ROSE, TRAVIS SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:SCOTT
Last Name:ROSE
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 1:2635 CAMINO DEL RIO S
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3726
Mailing Address - Country:US
Mailing Address - Phone:619-818-4306
Mailing Address - Fax:619-828-1030
Practice Address - Street 1:2635 CAMINO DEL RIO S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3726
Practice Address - Country:US
Practice Address - Phone:619-818-4306
Practice Address - Fax:619-828-1030
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32600111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician