Individual
TRAVIS Q JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
4304 W EMERALD ST, BOISE, ID 83706-2039
(208) 615-2537
Mailing address
4304 W EMERALD ST, BOISE, ID 83706-2039
(208) 615-2537
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
AC61091662
WA
171100000X
Acupuncturist
Primary
ACU-441
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC61091662
STATE
WA
01
—
ACU-441
STATE
ID
Enumeration date
03/05/2021
Last updated
12/16/2023
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