MEDICARE: ROBERT A SERVAIS JR. DC

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	111NN0400X	Neurology Chiropractor	1783	WI

General Provider Information

NPI Number	:	1619058526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT A SERVAIS JR. DC

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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