Provider Demographics
NPI:1982139713
Name:TRAVIS CHIROPRACTIC CENTER, UBO
Entity Type:Organization
Organization Name:TRAVIS CHIROPRACTIC CENTER, UBO
Other - Org Name:TRAVIS CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-321-4481
Mailing Address - Street 1:45 LOOP 150 W
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3930
Mailing Address - Country:US
Mailing Address - Phone:512-321-4481
Mailing Address - Fax:512-321-9737
Practice Address - Street 1:45 LOOP 150 W
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3930
Practice Address - Country:US
Practice Address - Phone:512-321-4481
Practice Address - Fax:512-321-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4037261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty