Provider Demographics
NPI:1942209812
Name:STANFORD, TRAVIS LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:LEE
Last Name:STANFORD
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 1:24128 STATE ROAD 35
Mailing Address - Street 2:PO BOX 31
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-8006
Mailing Address - Country:US
Mailing Address - Phone:715-349-2770
Mailing Address - Fax:715-349-8799
Practice Address - Street 1:24128 STATE ROAD 35
Practice Address - Street 2:
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-8006
Practice Address - Country:US
Practice Address - Phone:715-349-2770
Practice Address - Fax:715-349-8799
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3347-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor