Provider Demographics
NPI:1306396692
Name:BADGER, WILLIAM THEODORE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THEODORE
Last Name:BADGER
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 DANIELS ST STE 102A
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3070
Mailing Address - Country:US
Mailing Address - Phone:360-524-3390
Mailing Address - Fax:833-953-0018
Practice Address - Street 1:1112 DANIELS ST STE 102A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3070
Practice Address - Country:US
Practice Address - Phone:360-524-3390
Practice Address - Fax:833-953-0018
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC179544171100000X
WAAC60720897171100000X
OR4013175F00000X
WANT60720905175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist