Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH00002308 | WA |
NPI | 1508923277 |
---|---|
Provider Name | Cathy Ann Bangerter |
First Address | Bothell, WA 98011-3421 |
Second Address | Bothell, WA 98011-3421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2030039 | (05) | WA |
69092 | L & I (01) | WA |
BA5407 | REGENCE NUMBER (01) | WA |