Provider Demographics
NPI:1164693396
Name:NOVAK, CHARLES WILLARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLARD
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:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:RANGELY
Mailing Address - State:CO
Mailing Address - Zip Code:81648-0666
Mailing Address - Country:US
Mailing Address - Phone:970-675-2273
Mailing Address - Fax:
Practice Address - Street 1:402 W MAIN ST
Practice Address - Street 2:SUITE 135
Practice Address - City:RANGELY
Practice Address - State:CO
Practice Address - Zip Code:81648-2408
Practice Address - Country:US
Practice Address - Phone:970-675-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor