MEDICARE: MR. TRAVIS JOHN BANGERT DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1434	NE

General Provider Information

NPI Number	:	1538247895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRAVIS JOHN BANGERT DC

Provider Business Mailing Address
First Line	:	3700 S 9TH ST
Second Line	:	SUITE E
City	:	LINCOLN
State	:	NE
Zip	:	68502-5349
Country	:	US
Telephone Number	:	402-328-0028
Fax Number	:	402-328-0049

Provider Business Practice Location Address
First Line	:	3700 SOUTH 9TH
Second Line	:	SUITE E
City	:	LINCOLN
State	:	NE
Zip	:	68502
Country	:	US
Telephone Number	:	402-328-0028
Fax Number	:	402-328-0049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	03/09/2012

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