Provider Demographics
NPI:1609181114
Name:NOWAK FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NOWAK FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-783-8070
Mailing Address - Street 1:146 OAKLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2835
Mailing Address - Country:US
Mailing Address - Phone:860-783-8070
Mailing Address - Fax:860-783-8072
Practice Address - Street 1:146 OAKLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2835
Practice Address - Country:US
Practice Address - Phone:860-783-8070
Practice Address - Fax:860-783-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty