Healthcare Provider Details

I. General information

NPI: 1104804012
Provider Name (Legal Business Name): BAY AREA CHIROPRACTIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 08/20/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 BELLEVUE ST
GREEN BAY WI
54311-5605
US

IV. Provider business mailing address

1441 BELLEVUE ST
GREEN BAY WI
54311-5605
US

V. Phone/Fax

Practice location:
  • Phone: 920-468-1963
  • Fax: 920-468-9785
Mailing address:
  • Phone: 920-468-1963
  • Fax: 920-468-9785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT A SERVAIS JR.
Title or Position: OWNER
Credential: DC
Phone: 920-468-1963