Healthcare Provider Details

I. General information

NPI: 1164879318
Provider Name (Legal Business Name): TRAVIS LEE MASON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6308 MESQUITE DR NW
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

6308 MESQUITE DR NW
ALBUQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 302-332-3713
  • Fax:
Mailing address:
  • Phone: 302-332-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2140
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: