Provider Demographics
NPI:1538247895
Name:BANGERT, TRAVIS JOHN (DC)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:JOHN
Last Name:BANGERT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 S 9TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5349
Mailing Address - Country:US
Mailing Address - Phone:402-328-0028
Mailing Address - Fax:402-328-0049
Practice Address - Street 1:3700 SOUTH 9TH
Practice Address - Street 2:SUITE E
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502
Practice Address - Country:US
Practice Address - Phone:402-328-0028
Practice Address - Fax:402-328-0049
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor