Provider Demographics
NPI:1326457656
Name:MCDONALD, TRAVIS BRENT (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:BRENT
Last Name:MCDONALD
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 1:1205 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1371
Mailing Address - Country:US
Mailing Address - Phone:570-523-1221
Mailing Address - Fax:570-523-9246
Practice Address - Street 1:1205 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1371
Practice Address - Country:US
Practice Address - Phone:570-523-1221
Practice Address - Fax:570-523-9246
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor