Healthcare Provider Details

I. General information

NPI: 1619058526
Provider Name (Legal Business Name): ROBERT A SERVAIS JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
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 Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1783
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: