Healthcare Provider Details

I. General information

NPI: 1073713368
Provider Name (Legal Business Name): TRAVIS L NYBERG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 SUZANNE WAY STE 200
EUGENE OR
97408-7619
US

IV. Provider business mailing address

2650 SUZANNE WAY STE 200
EUGENE OR
97408-7619
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-3130
  • Fax: 541-228-3187
Mailing address:
  • Phone: 541-228-3130
  • Fax: 541-228-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number273481
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: