Provider Demographics
NPI:1821090523
Name:SANDERS, TRAVIS K (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:K
Last Name:SANDERS
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 1:545 W STATE ST STE 9
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-2271
Mailing Address - Country:US
Mailing Address - Phone:435-635-0614
Mailing Address - Fax:435-635-0661
Practice Address - Street 1:545 W STATE ST STE 9
Practice Address - Street 2:BACK IN BALANCE CHIROPRACTIC
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-2271
Practice Address - Country:US
Practice Address - Phone:435-635-0614
Practice Address - Fax:435-635-0661
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT75680021202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV38335Medicare ID - Type Unspecified