MEDICARE: BAY AREA CHIROPRACTIC SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104804012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA CHIROPRACTIC SC

Provider Business Mailing Address
First Line	:	1441 BELLEVUE ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5605
Country	:	US
Telephone Number	:	920-468-1963
Fax Number	:	920-468-9785

Provider Business Practice Location Address
First Line	:	1441 BELLEVUE ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5605
Country	:	US
Telephone Number	:	920-468-1963
Fax Number	:	920-468-9785

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT A SERVAIS JR.
Credential	:	DC
Telephone Number	:	920-468-1963

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	08/20/2025

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