Provider Demographics
NPI:1336534239
Name:TRAVIS IRISH, CHIROPRACTOR
Entity Type:Organization
Organization Name:TRAVIS IRISH, CHIROPRACTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:IRISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-580-0120
Mailing Address - Street 1:333 HAGGERTY LN STE 4
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-1780
Mailing Address - Country:US
Mailing Address - Phone:406-580-0120
Mailing Address - Fax:
Practice Address - Street 1:333 HAGGERTY LN STE 4
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-1780
Practice Address - Country:US
Practice Address - Phone:406-580-0120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI998261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center