Provider Demographics
NPI:1245429406
Name:ERIC W. NOVAK, DC, PLLC
Entity Type:Organization
Organization Name:ERIC W. NOVAK, DC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-886-9000
Mailing Address - Street 1:7200 W SAGINAW HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1133
Mailing Address - Country:US
Mailing Address - Phone:517-886-9000
Mailing Address - Fax:517-886-9002
Practice Address - Street 1:7200 W SAGINAW HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1133
Practice Address - Country:US
Practice Address - Phone:517-886-9000
Practice Address - Fax:517-886-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P22810Medicare PIN