MEDICARE: TRAVIS BANGERT DC PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538247895	OTHER	NE	PERSONAL NPI NUMBER

General Provider Information

NPI Number	:	1720147788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAVIS BANGERT DC PC

Provider Business Mailing Address
First Line	:	3121 S. 11TH STREET
Second Line	:
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	:	3121 S. 11TH STREET
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68502-5349
Country	:	US
Telephone Number	:	402-328-0028
Fax Number	:	402-328-0049

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. TRAVIS JOHN BANGERT
Credential	:	D.C.
Telephone Number	:	402-470-7050

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/25/2015

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