Healthcare Provider Details

I. General information

NPI: 1043374887
Provider Name (Legal Business Name): TRAVIS JAMES ELLIOTT ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5224 SHELBURNE RD STE 102
SHELBURNE VT
05482-6621
US

IV. Provider business mailing address

193 BEAVER CREEK RD
SHELBURNE VT
05482
US

V. Phone/Fax

Practice location:
  • Phone: 503-310-2036
  • Fax: 503-853-8615
Mailing address:
  • Phone: 802-497-2449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1281
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0110596
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: