Provider Demographics
NPI:1386820975
Name:TRAVELLER, JUSTIN BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BRUCE
Last Name:TRAVELLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1224 S RIVER RD
Mailing Address - Street 2:STE B100
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8365
Mailing Address - Country:US
Mailing Address - Phone:435-218-7250
Mailing Address - Fax:435-218-7251
Practice Address - Street 1:301 N 200 E
Practice Address - Street 2:SUITE 1B
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3010
Practice Address - Country:US
Practice Address - Phone:435-674-2626
Practice Address - Fax:435-628-5999
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6859851-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$001Medicaid