Provider Demographics
NPI:1538307384
Name:TRAVIS J. ELLIOTT ND LLC
Entity type:Organization
Organization Name:TRAVIS J. ELLIOTT ND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-206-7773
Mailing Address - Street 1:1305 SW STEPHENSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-8200
Mailing Address - Country:US
Mailing Address - Phone:503-310-2036
Mailing Address - Fax:866-202-3703
Practice Address - Street 1:1340 SW BERTHA BLVD,
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219
Practice Address - Country:US
Practice Address - Phone:503-244-0500
Practice Address - Fax:503-853-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1281175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty