Provider Demographics
NPI:1093796757
Name:NOVAK, MARTIN L (DC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
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 1:5804 TORRANCE DR
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-8803
Mailing Address - Country:US
Mailing Address - Phone:724-327-8279
Mailing Address - Fax:
Practice Address - Street 1:527 SHADY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4437
Practice Address - Country:US
Practice Address - Phone:412-661-5000
Practice Address - Fax:412-661-4192
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004531L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012766210002Medicaid
PAU10153Medicare UPIN
PA0012766210002Medicaid