Provider Demographics
NPI:1245578855
Name:BARGE CHIROPRACTIC FAMILY & WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:BARGE CHIROPRACTIC FAMILY & WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-781-9777
Mailing Address - Street 1:3812 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9466
Mailing Address - Country:US
Mailing Address - Phone:608-781-9777
Mailing Address - Fax:608-781-9747
Practice Address - Street 1:3812 CREEKSIDE LN
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9466
Practice Address - Country:US
Practice Address - Phone:608-781-9777
Practice Address - Fax:608-781-9747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035271Medicare PIN