Provider Demographics
NPI:1053537704
Name:SERVI, KEVIN MARK (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MARK
Last Name:SERVI
Suffix:
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 1:1425 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045
Mailing Address - Country:US
Mailing Address - Phone:414-616-9999
Mailing Address - Fax:414-616-7777
Practice Address - Street 1:3975 N 68TH ST
Practice Address - Street 2:#204
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216
Practice Address - Country:US
Practice Address - Phone:414-616-9999
Practice Address - Fax:414-616-7777
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor