Provider Demographics
NPI:1811089733
Name:SNOW, TRAVIS RAY (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:RAY
Last Name:SNOW
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 1:420 N MAPLE STREET
Mailing Address - Street 2:P.O. BOX 267
Mailing Address - City:ORLEANS
Mailing Address - State:IN
Mailing Address - Zip Code:47452
Mailing Address - Country:US
Mailing Address - Phone:812-865-3052
Mailing Address - Fax:812-865-3206
Practice Address - Street 1:420 N MAPLE STREET
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:IN
Practice Address - Zip Code:47452
Practice Address - Country:US
Practice Address - Phone:812-865-3052
Practice Address - Fax:812-865-3206
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002299A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000528221OtherANTHEM
IN200908540Medicaid
IN200908540Medicaid