Provider Demographics
NPI:1053587675
Name:BARSAMIAN, GEORGE A (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:BARSAMIAN
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 1:1009 HIGHWAY NN E
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1017
Mailing Address - Country:US
Mailing Address - Phone:262-363-4500
Mailing Address - Fax:
Practice Address - Street 1:1009 HIGHWAY NN E
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1017
Practice Address - Country:US
Practice Address - Phone:262-363-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-03
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70488Medicare PIN