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General NPI Number Information
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NPI Number | 1568870061
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Entity Type | Individual
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Provider Name | JORDAN TRAVIS D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 2618 W MARTIN LUTHER KING BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-7698
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Country | US
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Telephone | 479-521-7755
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Fax | 479-521-6965
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Provider Business Mailing Address
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Address Line | 2618 MLK JR BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-7698
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Country | US
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Telephone | 479-521-7755
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Fax | 479-521-6965
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 16070
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 16070
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License Number State | AR
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