Provider Demographics
NPI:1508923277
Name:BANGERTER, CATHY ANN (DC)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:ANN
Last Name:BANGERTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10116 MAIN ST STE B2
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3449
Mailing Address - Country:US
Mailing Address - Phone:425-485-1464
Mailing Address - Fax:
Practice Address - Street 1:10116 MAIN ST STE B2
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3449
Practice Address - Country:US
Practice Address - Phone:425-485-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002308111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA69092OtherL & I
WABA5407OtherREGENCE NUMBER
WA2030039Medicaid