Provider Demographics
NPI:1114069978
Name:TRAVIS CHIROPRACTIC
Entity Type:Organization
Organization Name:TRAVIS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-443-0551
Mailing Address - Street 1:3400 BUTTONWOOD DR
Mailing Address - Street 2:STE C
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3720
Mailing Address - Country:US
Mailing Address - Phone:573-443-0551
Mailing Address - Fax:573-442-2959
Practice Address - Street 1:3400 BUTTONWOOD DR
Practice Address - Street 2:STE C
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3720
Practice Address - Country:US
Practice Address - Phone:573-443-0551
Practice Address - Fax:573-442-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherTAX ID