Provider Demographics
NPI:1265802110
Name:MCDERMOTT, TRAVIS (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:MCDERMOTT
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 1:7504 HIGHWAY 72 W
Mailing Address - Street 2:SUITE A6
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9554
Mailing Address - Country:US
Mailing Address - Phone:256-400-1785
Mailing Address - Fax:
Practice Address - Street 1:7504 HIGHWAY 72 W
Practice Address - Street 2:SUITE A6
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9554
Practice Address - Country:US
Practice Address - Phone:256-400-1785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL2435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor