Individual
MR. TRAVIS JON SHOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2400 32ND AVE S, FARGO, ND 58103-5800
(218) 643-2694
Mailing address
1510 AVENUE B, WAHPETON, ND 58075-3760
(701) 672-4513
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
1792
MN
2255A2300X
Athletic Trainer
Primary
271-03
ND
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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