Provider Demographics
NPI:1164699831
Name:NOVELLI CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:NOVELLI CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:NOVELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-497-1942
Mailing Address - Street 1:525 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2566
Mailing Address - Country:US
Mailing Address - Phone:330-497-1942
Mailing Address - Fax:330-497-0619
Practice Address - Street 1:525 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2566
Practice Address - Country:US
Practice Address - Phone:330-497-1942
Practice Address - Fax:330-497-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty