MEDICARE: DR. JORDAN TRAVIS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	16070	AR
2	111N00000X	Chiropractor	16070	AR

General Provider Information

NPI Number	:	1568870061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN TRAVIS D.C.

Provider Business Mailing Address
First Line	:	2618 MLK JR BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-7698
Country	:	US
Telephone Number	:	479-521-7755
Fax Number	:	479-521-6965

Provider Business Practice Location Address
First Line	:	2618 W MARTIN LUTHER KING BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-7698
Country	:	US
Telephone Number	:	479-521-7755
Fax Number	:	479-521-6965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	03/26/2024

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