Provider Demographics
NPI:1063664555
Name:TRAVIS HOWARD NORTH, INC
Entity Type:Organization
Organization Name:TRAVIS HOWARD NORTH, INC
Other - Org Name:ANDERSON CHIROPRACTIC NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-299-7000
Mailing Address - Street 1:1826 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-1423
Mailing Address - Country:US
Mailing Address - Phone:812-460-1200
Mailing Address - Fax:812-460-1202
Practice Address - Street 1:1826 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-1423
Practice Address - Country:US
Practice Address - Phone:812-460-1200
Practice Address - Fax:812-460-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002232A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20091600AMedicaid