Provider Demographics
NPI:1750421244
Name:BARGE, PATRICIA LYN (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYN
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 1:3812 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:
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:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38927600Medicaid