Healthcare Provider Details

I. General information

NPI: 1104956036
Provider Name (Legal Business Name): TRAVIS LOWERY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ST SE STE A
TUMWATER WA
98501-5200
US

IV. Provider business mailing address

200 W ST SE STE A
TUMWATER WA
98501-5200
US

V. Phone/Fax

Practice location:
  • Phone: 360-786-8600
  • Fax: 360-786-8603
Mailing address:
  • Phone: 360-786-8600
  • Fax: 360-786-8603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00033825
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: