Healthcare Provider Details

I. General information

NPI: 1720046428
Provider Name (Legal Business Name): GEORGE WILLIAM BERRES D.C.,C.C.S.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 MAIN ST
COLFAX WI
54730-9148
US

IV. Provider business mailing address

PO BOX 265 617 MAIN STREET
COLFAX WI
54730-0265
US

V. Phone/Fax

Practice location:
  • Phone: 715-962-3225
  • Fax: 715-962-3225
Mailing address:
  • Phone: 715-962-3225
  • Fax: 715-962-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2087
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: