Individual
TRAVIS J ROEDOCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1001 20TH AVE SW, MINOT, ND 58701
(701) 852-0158
(701) 852-5630
Mailing address
1001 20TH AVE SW, MINOT, ND 58701
(701) 852-0158
(701) 852-5630
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
716
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10810
CLINIC MEDICAID
—
05
—
12206
—
ND
01
—
711180
GROUP PROVIDER #
—
Enumeration date
07/12/2006
Last updated
07/08/2007
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