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General NPI Number Information
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NPI Number | 1538436423
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Entity Type | Organization
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Legal Business Name | TRAVIS D. BROUGHTON
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 223 W IRONWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2651
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Country | US
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Telephone | 208-215-3261
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Fax | 208-966-4284
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Provider Business Mailing Address
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Address Line | 223 W IRONWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2651
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Country | US
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Telephone | 208-215-3261
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Fax | 208-966-4284
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. TRAVIS DERRILL BROUGHTON
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Credential | D.C.
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Telephone | 509-220-0872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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