Travis Q Johnson, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

ACU-441 Issued in ID

Practice address

4304 W Emerald St
Boise, ID 83706-2039

Phone

(208) 615-2537

NPI assigned

Mar 5, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Living Wellness Acupuncture & Integrative Medicines

  • Acupuncturist
  • Boise, ID
  • NPI 1659242162
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702684800000",
    "number": "1902491541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4304 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837062039",
            "telephone_number": "208-615-2537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4304 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837062039",
            "telephone_number": "208-615-2537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TRAVIS",
        "middle_name": "Q",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-05",
        "last_updated": "2023-12-16",
        "certification_date": "2023-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "ID",
            "license": "ACU-441",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "WA",
            "license": "AC61091662",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "AC61091662",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "ACU-441",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Ann Johnson, LMSW
• Shae Hal Johnson, DO
• Skye J Johnson, LMSW
• Suzanne Johnson, LMSW
• Taylor Kadence Johnson
• Troy L Johnson, MD
• Valerie Johnson
• Vanessa Johnson
• Wendy Johnson, OT
• James M Johnston, MD

• Acupuncturist in Boise, ID
• Providers in Boise, ID by specialty
• Acupuncturist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.