Provider Demographics
NPI:1568520815
Name:NOVICKY, STEVEN D (DC, DACRB)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:NOVICKY
Suffix:
Gender:M
Credentials:DC, DACRB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 DEER SPRING RUN
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-7613
Mailing Address - Country:US
Mailing Address - Phone:330-533-2882
Mailing Address - Fax:330-533-3828
Practice Address - Street 1:4247 BELMONT AVE STE 1
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1003
Practice Address - Country:US
Practice Address - Phone:330-759-9912
Practice Address - Fax:330-759-9914
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2138111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104827Medicaid
OHU52717Medicare UPIN
OH0104827Medicaid