Healthcare Provider Details

I. General information

NPI: 1730502501
Provider Name (Legal Business Name): STEPHEN BOGERT L AC, CH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 KEY ST STE 106
BELLINGHAM WA
98225-5232
US

IV. Provider business mailing address

1116 KEY ST STE 106
BELLINGHAM WA
98225-5232
US

V. Phone/Fax

Practice location:
  • Phone: 360-756-9793
  • Fax: 360-752-9007
Mailing address:
  • Phone: 360-756-9793
  • Fax: 360-752-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60437922
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberHP60239225
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: