Provider Demographics
NPI:1114497112
Name:NOVO CHIROPRACTIC NORTH, PLLC
Entity Type:Organization
Organization Name:NOVO CHIROPRACTIC NORTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEERBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-259-9835
Mailing Address - Street 1:2355 BELMONT CENTER DR NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8715
Mailing Address - Country:US
Mailing Address - Phone:616-259-9835
Mailing Address - Fax:
Practice Address - Street 1:2355 BELMONT CENTER DR NE STE 100
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-8715
Practice Address - Country:US
Practice Address - Phone:616-538-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty