Provider Demographics
NPI:1043374887
Name:ELLIOTT, TRAVIS JAMES (ND)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:JAMES
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 BEAVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482
Mailing Address - Country:US
Mailing Address - Phone:802-497-2449
Mailing Address - Fax:
Practice Address - Street 1:5224 SHELBURNE RD STE 102
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6621
Practice Address - Country:US
Practice Address - Phone:503-310-2036
Practice Address - Fax:503-853-8615
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1281175F00000X
VT099.0110596175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath