Provider Demographics
NPI:1912175704
Name:HART, TRAVIS MARC (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:MARC
Last Name:HART
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 1:22 COMMERCE ST
Mailing Address - Street 2:UNIT 8A
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461-9303
Mailing Address - Country:US
Mailing Address - Phone:802-482-4476
Mailing Address - Fax:802-329-2220
Practice Address - Street 1:22 COMMERCE ST
Practice Address - Street 2:UNIT 8A
Practice Address - City:HINESBURG
Practice Address - State:VT
Practice Address - Zip Code:05461-9303
Practice Address - Country:US
Practice Address - Phone:802-482-4476
Practice Address - Fax:802-329-2220
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor