Provider Demographics
NPI:1518038983
Name:NOVOSELSKY, JASON CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHARLES
Last Name:NOVOSELSKY
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 1:2391 CATAMARAN CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1771
Mailing Address - Country:US
Mailing Address - Phone:404-521-3950
Mailing Address - Fax:404-521-3952
Practice Address - Street 1:1332 MAY AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2008
Practice Address - Country:US
Practice Address - Phone:404-521-3950
Practice Address - Fax:404-521-3952
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHCGMedicare ID - Type Unspecified