Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 099.0110596 | VT |
N | 175F00000X | Naturopath | 1281 | OR |
NPI | 1043374887 |
---|---|
Provider Name | Dr. Travis James Elliott |
First Address | Shelburne, VT 05482 |
Second Address | Shelburne, VT 05482-6621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 16/07/2015 |