Provider Demographics
NPI:1801004692
Name:GARVEY CHIROPRACTIC L.L.C.
Entity Type:Organization
Organization Name:GARVEY CHIROPRACTIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-494-8008
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4305261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1598983611OtherPERSONAL NPI
WI4305-012OtherSTATE LICENSE