Provider Demographics
NPI:1942209465
Name:BURGARINO, JOSEPH SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SAMUEL
Last Name:BURGARINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 N 124TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4622
Mailing Address - Country:US
Mailing Address - Phone:262-789-1955
Mailing Address - Fax:262-789-1955
Practice Address - Street 1:2511 N 124TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4622
Practice Address - Country:US
Practice Address - Phone:262-789-1955
Practice Address - Fax:262-789-1955
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1356-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38804900Medicaid
WI000075026Medicare ID - Type Unspecified