Provider Demographics
NPI:1053509638
Name:GERHART, TRAVIS WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:WAYNE
Last Name:GERHART
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 1:4934 CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-1202
Mailing Address - Country:US
Mailing Address - Phone:971-258-8750
Mailing Address - Fax:
Practice Address - Street 1:14001 RIDGEDALE DR STE 390
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305
Practice Address - Country:US
Practice Address - Phone:952-893-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4026111N00000X
MN5020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor