Provider Demographics
NPI:1558396796
Name:TRAVIS HOWARD INC
Entity Type:Organization
Organization Name:TRAVIS HOWARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-299-7000
Mailing Address - Street 1:4320 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4301
Mailing Address - Country:US
Mailing Address - Phone:812-299-7000
Mailing Address - Fax:812-299-7001
Practice Address - Street 1:4320 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4301
Practice Address - Country:US
Practice Address - Phone:812-299-7000
Practice Address - Fax:812-299-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200834140AMedicaid
IN248450Medicare PIN