Provider Demographics
NPI:1720046428
Name:BERRES, GEORGE WILLIAM (DC,CCSP)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:BERRES
Suffix:
Gender:M
Credentials:DC,CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:617 MAIN STREET
Mailing Address - City:COLFAX
Mailing Address - State:WI
Mailing Address - Zip Code:54730-0265
Mailing Address - Country:US
Mailing Address - Phone:715-962-3225
Mailing Address - Fax:715-962-3225
Practice Address - Street 1:617 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WI
Practice Address - Zip Code:54730-9148
Practice Address - Country:US
Practice Address - Phone:715-962-3225
Practice Address - Fax:715-962-3225
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2087111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38793900Medicaid
WI75328Medicare ID - Type Unspecified