1083675417 NPI number — BARGE & BARGE CHIROPRACTIC CENTER LTD

Table of content: (NPI 1083675417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083675417 NPI number — BARGE & BARGE CHIROPRACTIC CENTER LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARGE & BARGE CHIROPRACTIC CENTER LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083675417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2045 32ND ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54601-7026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-788-7118
Provider Business Mailing Address Fax Number:
608-787-6171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2045 32ND ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54601-7026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-788-7118
Provider Business Practice Location Address Fax Number:
608-787-6171
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARGE
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
608-788-7118

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 38980000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90245BA . This is a "BC/BS MN PROVIDER #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 931234949017 . This is a "BC/BS WI PROVIDER#" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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