Provider Demographics
NPI:1598936544
Name:CHIROCENTER INC
Entity Type:Organization
Organization Name:CHIROCENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:ALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-781-6035
Mailing Address - Street 1:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-0955
Mailing Address - Country:US
Mailing Address - Phone:435-781-6035
Mailing Address - Fax:435-781-6040
Practice Address - Street 1:1781 W 1000 S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078
Practice Address - Country:US
Practice Address - Phone:435-781-6035
Practice Address - Fax:435-781-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5322825-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6110Medicaid
U97275Medicare UPIN