Provider Demographics
NPI:1801850417
Name:OLLER, TRAVIS R (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:R
Last Name:OLLER
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 1:1408 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1819
Mailing Address - Country:US
Mailing Address - Phone:785-233-2300
Mailing Address - Fax:785-233-2320
Practice Address - Street 1:1408 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66612-1819
Practice Address - Country:US
Practice Address - Phone:785-234-0521
Practice Address - Fax:785-234-2405
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000062160OtherBCBS
KS0000062160OtherBCBS
KS062160Medicare ID - Type UnspecifiedMEDICARE