Provider Demographics
NPI: | 1508276312 |
---|---|
Name: | OWENS, TRAVIS BENJAMIN (DC) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | TRAVIS |
Middle Name: | BENJAMIN |
Last Name: | OWENS |
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 700688 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN ANTONIO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78270-0688 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-404-6050 |
Mailing Address - Fax: | 866-313-3397 |
Practice Address - Street 1: | 5000 SCHERTZ PKWY STE 401 |
Practice Address - Street 2: | |
Practice Address - City: | SCHERTZ |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78154-1457 |
Practice Address - Country: | US |
Practice Address - Phone: | 800-404-6050 |
Practice Address - Fax: | 866-313-3397 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-05-01 |
Last Update Date: | 2023-11-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 13049 | 111NR0400X, 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | |
Yes | 111NR0400X | Chiropractic Providers | Chiropractor | Rehabilitation |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 13049 | Other | CHIROPRACTIC LICENSE |
VA | 0104557710 | Other | CHIROPRACTIC LICENSE |
OH | DC-05084 | Other | CHIROPRACTIC LICENSE |