Provider Demographics
NPI:1205374550
Name:SIMMONS, TRAVIS (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:SIMMONS
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 1:8524 W GAGE BLVD
Mailing Address - Street 2:BLDG A-1 BOX 319
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8241
Mailing Address - Country:US
Mailing Address - Phone:509-591-0070
Mailing Address - Fax:
Practice Address - Street 1:7401 W HOOD PL STE 200
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3400
Practice Address - Country:US
Practice Address - Phone:509-591-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60726082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor