Physician Compare National (NPI:1851838064)

HEALTHCARE PROVIDER: TRAVIS LEE KLUG

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1851838064
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1052664760
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20181026001055
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KLUG
	Individual professional last name
Provider First Name	TRAVIS
	Individual professional first name
Provider Middle Name	LEE
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LOGAN COLLEGE OF CHIROPRACTIC
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1060 CURVE CREST BLVD W
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 102
	Group Practice or individual's line 2 address
City	STILLWATER
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	550826058
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6515710201
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M