Provider Demographics
NPI:1225082118
Name:ALLAN, TRAVIS RAY (DC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:RAY
Last Name:ALLAN
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:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-0955
Mailing Address - Country:US
Mailing Address - Phone:435-781-6035
Mailing Address - Fax:435-781-6040
Practice Address - Street 1:1781 W 1000 S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4115
Practice Address - Country:US
Practice Address - Phone:435-781-6035
Practice Address - Fax:435-781-6040
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5322825-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor