Provider Demographics
NPI:1073574430
Name:BARGE, PAMELA J (DC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:BARGE
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 1:2045 32ND ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7026
Mailing Address - Country:US
Mailing Address - Phone:608-788-7118
Mailing Address - Fax:608-787-6171
Practice Address - Street 1:2045 32ND ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7026
Practice Address - Country:US
Practice Address - Phone:608-788-7118
Practice Address - Fax:608-787-6171
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI350022905OtherRR MEDICARE#
MN90247SCOtherBC/BS INDIVIDUAL#
WI38828300Medicaid
MN90247SCOtherBC/BS INDIVIDUAL#
WI350022905OtherRR MEDICARE#