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General NPI Number Information
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NPI Number | 1982139713
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Entity Type | Organization
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Legal Business Name | TRAVIS CHIROPRACTIC CENTER, UBO
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Dates
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Enumeration Date | 04/30/2017
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Last Update Date | 04/30/2017
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Provider Practice Location Address
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Address Line | 45 LOOP 150 W
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City | BASTROP
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State | TX
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Zip | 78602-3930
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Country | US
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Telephone | 512-321-4481
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Fax | 512-321-9737
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Provider Business Mailing Address
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Address Line | 45 LOOP 150 W
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City | BASTROP
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State | TX
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Zip | 78602-3930
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Country | US
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Telephone | 512-321-4481
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Fax | 512-321-9737
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DR. EDWIN J TRAVIS
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Credential | D.C.
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Telephone | 512-321-4481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 4037
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License Number State | TX
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