Provider Demographics
NPI:1851838064
Name:KLUG, TRAVIS LEE
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEE
Last Name:KLUG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TRAVIS
Other - Middle Name:LEE
Other - Last Name:KLUG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1219 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-1203
Mailing Address - Country:US
Mailing Address - Phone:715-727-3150
Mailing Address - Fax:
Practice Address - Street 1:1219 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-1203
Practice Address - Country:US
Practice Address - Phone:715-727-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor