Healthcare Provider Details

I. General information

NPI: 1720147788
Provider Name (Legal Business Name): TRAVIS BANGERT DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 S. 11TH STREET
LINCOLN NE
68502-5349
US

IV. Provider business mailing address

3121 S. 11TH STREET
LINCOLN NE
68502-5349
US

V. Phone/Fax

Practice location:
  • Phone: 402-328-0028
  • Fax: 402-328-0049
Mailing address:
  • Phone: 402-328-0028
  • Fax: 402-328-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1434
License Number StateNE

VIII. Authorized Official

Name: DR. TRAVIS JOHN BANGERT
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 402-470-7050