Provider Demographics
NPI:1578688693
Name:NOVAK, MICHAEL A (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:NOVAK
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:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0397
Mailing Address - Country:US
Mailing Address - Phone:740-321-1214
Mailing Address - Fax:740-321-1264
Practice Address - Street 1:204 MUNSON ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1284
Practice Address - Country:US
Practice Address - Phone:740-321-1214
Practice Address - Fax:740-321-1264
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC2978111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4087711Medicare PIN