Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3823 | OK |
NPI | 1003027103 |
---|---|
Provider Name | Heath D Travis |
First Address | Sapulpa, OK 74066-4634 |
Second Address | Sapulpa, OK 74066-4634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 15/01/2010 |