MEDICARE: JT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	7218960-1202	UT
2	111NS0005X	Sports Physician Chiropractor	6859851-1202	UT

General Provider Information

NPI Number	:	1770033672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JT LLC

Provider Business Mailing Address
First Line	:	1865 S 2740 E
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-7110
Country	:	US
Telephone Number	:	435-256-2823
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 N 200 E
Second Line	:	SUITE 2C
City	:	SAINT GEORGE
State	:	UT
Zip	:	84770-3010
Country	:	US
Telephone Number	:	435-218-7250
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUSTIN TRAVELLER
Credential	:	M.S. D.C.
Telephone Number	:	435-256-2823

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	12/20/2016

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Directions to “JT LLC ” Practice Location

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