Provider Demographics
NPI:1609252949
Name:KATIE L. NOVOSEL CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:KATIE L. NOVOSEL CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOVOSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-857-4011
Mailing Address - Street 1:PO BOX 1815
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1815
Mailing Address - Country:US
Mailing Address - Phone:201-857-4011
Mailing Address - Fax:201-389-3498
Practice Address - Street 1:160 BROADWAY
Practice Address - Street 2:EAST BUILDING, 6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4201
Practice Address - Country:US
Practice Address - Phone:201-857-4011
Practice Address - Fax:201-389-3498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty