Provider Demographics
NPI:1144463928
Name:KERSHNER, TRAVIS MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:MICHAEL
Last Name:KERSHNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N LYONS ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-2131
Mailing Address - Country:US
Mailing Address - Phone:660-679-4423
Mailing Address - Fax:
Practice Address - Street 1:101 N LYONS ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-2131
Practice Address - Country:US
Practice Address - Phone:660-679-4423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007037820111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist