Provider Demographics
NPI:1003027103
Name:TRAVIS, HEATH D (DC)
Entity Type:Individual
Prefix:
First Name:HEATH
Middle Name:D
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 1:8 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4634
Mailing Address - Country:US
Mailing Address - Phone:918-224-2225
Mailing Address - Fax:918-224-3022
Practice Address - Street 1:8 S MISSION ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4634
Practice Address - Country:US
Practice Address - Phone:918-224-2225
Practice Address - Fax:918-224-3022
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor