Provider Demographics
NPI:1083621890
Name:NOVAK, ERIC WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:NOVAK
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 1:705 SNOW RD
Mailing Address - Street 2:STE 1
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4086
Mailing Address - Country:US
Mailing Address - Phone:517-886-9000
Mailing Address - Fax:517-886-9002
Practice Address - Street 1:705 SNOW RD
Practice Address - Street 2:STE 1
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4086
Practice Address - Country:US
Practice Address - Phone:517-886-9000
Practice Address - Fax:517-886-9002
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B310660OtherBCBS MICHIGAN
MI4784384Medicaid
MIP22810001Medicare ID - Type UnspecifiedMEMBER #
MI4784384Medicaid