Provider Demographics
NPI:1598983611
Name:GARVEY PINTAR, JOLENE MARIE (DC)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:MARIE
Last Name:GARVEY PINTAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PACKERLAND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-4861
Mailing Address - Country:US
Mailing Address - Phone:920-494-8008
Mailing Address - Fax:920-494-1844
Practice Address - Street 1:110 PACKERLAND DR
Practice Address - Street 2:SUITE B
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-4861
Practice Address - Country:US
Practice Address - Phone:920-494-8008
Practice Address - Fax:920-494-1844
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4305OtherSTATE LISCENSE NUMBER
WI14-1995954OtherEIN