Provider Demographics
NPI:1760507222
Name:BAMBERGER, STEPHAN (PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:BAMBERGER
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 100TH ST SW
Mailing Address - Street 2:SUITE B-201
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-2722
Mailing Address - Country:US
Mailing Address - Phone:425-355-4176
Mailing Address - Fax:
Practice Address - Street 1:215 100TH ST SW
Practice Address - Street 2:SUITE B-201
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-2722
Practice Address - Country:US
Practice Address - Phone:425-355-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000417171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist