Provider Demographics
NPI:1285865949
Name:WHITE, TRAVIS LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:LEE
Last Name:WHITE
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 1218
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-1218
Mailing Address - Country:US
Mailing Address - Phone:970-533-1024
Mailing Address - Fax:970-533-1025
Practice Address - Street 1:164 E. FRONTAGE ST
Practice Address - Street 2:
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81328
Practice Address - Country:US
Practice Address - Phone:970-533-1024
Practice Address - Fax:970-533-1025
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor