Provider Demographics
NPI:1902005861
Name:TRAVIS, MICHAEL B (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:TRAVIS
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 1:374 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-1102
Mailing Address - Country:US
Mailing Address - Phone:270-906-2700
Mailing Address - Fax:
Practice Address - Street 1:374 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1102
Practice Address - Country:US
Practice Address - Phone:270-906-2700
Practice Address - Fax:270-906-2800
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5058111N00000X
KY249695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor