Provider Demographics
NPI:1063618718
Name:PALEVAC, BRIAN E (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:PALEVAC
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 1:3221 VOYAGER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8349
Mailing Address - Country:US
Mailing Address - Phone:920-256-0392
Mailing Address - Fax:
Practice Address - Street 1:3221 VOYAGER DR STE 1
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-8349
Practice Address - Country:US
Practice Address - Phone:414-529-5972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor