1033733662 NPI number — JT CHIRO INC

Table of content: MRS. LISA MARIE TRAVIS P.T. (NPI 1598165235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033733662 NPI number — JT CHIRO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JT CHIRO INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033733662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307 NW 8TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33426-2935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-846-1233
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 NE SPANISH RIVER BLVD
Provider Second Line Business Practice Location Address:
STE 35
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33431-4517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-338-5111
Provider Business Practice Location Address Fax Number:
561-338-0580
Provider Enumeration Date:
05/29/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-846-1233

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)