Provider Demographics
NPI:1407897432
Name:SCOTT, TRAVIS PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:PATRICK
Last Name:SCOTT
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 1:15067 CRESTONE AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-4586
Mailing Address - Country:US
Mailing Address - Phone:952-322-4440
Mailing Address - Fax:952-322-4442
Practice Address - Street 1:15067 CRESTONE AVE W
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-4586
Practice Address - Country:US
Practice Address - Phone:952-322-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004056Medicare PIN