Healthcare Provider Details

I. General information

NPI: 1508923277
Provider Name (Legal Business Name): CATHY ANN BANGERTER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10116 MAIN ST STE B2
BOTHELL WA
98011-3449
US

IV. Provider business mailing address

10116 MAIN ST STE B2
BOTHELL WA
98011-3449
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-1464
  • Fax:
Mailing address:
  • Phone: 425-485-1464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH00002308
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier69092
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL & I
# 2
IdentifierBA5407
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerREGENCE NUMBER
# 3
Identifier2030039
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: