Organization Active NPI

Bay Area Chiropractic SC

  • Chiropractor
  • Green Bay, WI
National Provider Identifier
1104804012
Registry record updated Aug 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
BAY AREA CHIROPRACTIC SC
Practice address
1441 Bellevue St
Green Bay, WI 54311-5605
Phone
(920) 468-1963
Fax
(920) 468-9785
NPI assigned
Jan 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert A Servais Jr., DCNPI 1619058526
Title
Owner
Phone
(920) 468-1963

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X Primary

Addresses

Primary practice location

1441 Bellevue St
Green Bay, WI 54311-5605

Mailing address

1441 Bellevue St
Green Bay, WI 54311-5605
Phone (920) 468-1963

Other identifiers 1

IdentifierTypeStateIssuer
39001100MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041105000042 WI Part B Supplier - Clinic/Group Practice 2860455417 Receives reassigned benefits from 3 practitioners
Practice locations: Green Bay, WI

National Provider Directory

National Provider Directory

Locations

1441 Bellevue St
Green Bay, WI 54311
Phone (920) 465-7772

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755648000000",
    "number": "1104804012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 BELLEVUE ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115605",
            "telephone_number": "920-468-1963",
            "fax_number": "920-468-9785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 BELLEVUE ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115605",
            "telephone_number": "920-468-1963",
            "fax_number": "920-468-9785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA CHIROPRACTIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-03",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-08",
        "status": "A",
        "authorized_official_last_name": "SERVAIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-468-1963",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39001100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.