Provider Demographics
NPI:1740386960
Name:TRAVIS, BROOKS M (DC)
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:M
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 1:605 WILDROSE PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6796
Mailing Address - Country:US
Mailing Address - Phone:573-424-2254
Mailing Address - Fax:573-442-2959
Practice Address - Street 1:3400 BUTTONWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3720
Practice Address - Country:US
Practice Address - Phone:573-443-0551
Practice Address - Fax:573-442-2959
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU84702Medicare UPIN