Provider Demographics
NPI:1063578128
Name:ELLIOTT, TRAVIS (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S SENECA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-2807
Mailing Address - Country:US
Mailing Address - Phone:307-746-9200
Mailing Address - Fax:307-746-9200
Practice Address - Street 1:1 S SENECA AVE STE A
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2807
Practice Address - Country:US
Practice Address - Phone:307-746-9200
Practice Address - Fax:307-746-9200
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601610Medicaid
P00068676OtherRAILROAD MEDICARE
U94057Medicare UPIN
SD7601610Medicaid