Provider Demographics
NPI:1508166844
Name:NOVICKY, TIMOTHY GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GERARD
Last Name:NOVICKY
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 1:8098 E MARKET ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2270
Mailing Address - Country:US
Mailing Address - Phone:330-717-3550
Mailing Address - Fax:330-617-4270
Practice Address - Street 1:8098 E MARKET ST
Practice Address - Street 2:SUITE #2
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2270
Practice Address - Country:US
Practice Address - Phone:330-717-3550
Practice Address - Fax:330-617-4270
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor