Provider Demographics
NPI:1689607111
Name:BUCKMASTER, TRAVIS LEE (LAC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEE
Last Name:BUCKMASTER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 LANCASTER DR NE STE 111
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1066
Mailing Address - Country:US
Mailing Address - Phone:503-371-8770
Mailing Address - Fax:
Practice Address - Street 1:1880 LANCASTER DR NE STE 111
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1066
Practice Address - Country:US
Practice Address - Phone:503-371-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2018-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00588171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist