Provider Demographics
NPI:1619058526
Name:SERVAIS, ROBERT A JR (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:SERVAIS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 BELLEVUE ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5605
Mailing Address - Country:US
Mailing Address - Phone:920-468-1963
Mailing Address - Fax:920-468-9785
Practice Address - Street 1:1441 BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5605
Practice Address - Country:US
Practice Address - Phone:920-468-1963
Practice Address - Fax:920-468-9785
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1783111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology