Travis R Wilkins, D.C.
Individual provider Active NPI Chiropractor · Shelley, ID
NPI 1962436253 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1962436253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIA-973 (ID)
- Practice address
- 528 N State St
Shelley, ID 83274-1154 - Phone
- (208) 357-0333
- Fax
- (208) 357-2299
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifetime Wellness Chiropractic PLLC | Chiropractor | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHIA-973 | ID | Yes |
Addresses
Primary practice location
528 N State St
Shelley, ID 83274-1154
Mailing address
528 N State St
Shelley, ID 83274-1154
Phone (208) 357-0333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C4009 | Other | ID | BLUE CROSS |
Other providers in Shelley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.