Provider Demographics
NPI:1093765885
Name:DAVIS, TRAVIS E (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:E
Last Name:DAVIS
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:PO BOX 8563
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-8563
Mailing Address - Country:US
Mailing Address - Phone:620-672-3731
Mailing Address - Fax:620-672-3731
Practice Address - Street 1:122 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-2710
Practice Address - Country:US
Practice Address - Phone:620-672-3731
Practice Address - Fax:620-672-3731
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060013OtherBCBSK
KS060013Medicare ID - Type Unspecified