Provider Demographics
NPI:1538258785
Name:BARKALOW, TERRENCE R (DC)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:R
Last Name:BARKALOW
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:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982-0667
Mailing Address - Country:US
Mailing Address - Phone:920-787-4715
Mailing Address - Fax:920-787-1083
Practice Address - Street 1:200 N OAKRIDGE CT
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-8405
Practice Address - Country:US
Practice Address - Phone:920-787-4715
Practice Address - Fax:920-787-1083
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38773900Medicaid
WI35767Medicare ID - Type Unspecified
WI000135767Medicare PIN
WIT61417Medicare UPIN