Provider Demographics
NPI:1639117336
Name:NOWACK, DENNIS (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:NOWACK
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 1:4265 SW 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3028
Mailing Address - Country:US
Mailing Address - Phone:503-754-1875
Mailing Address - Fax:503-643-1006
Practice Address - Street 1:4265 SW 109TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3028
Practice Address - Country:US
Practice Address - Phone:503-754-1875
Practice Address - Fax:503-643-1006
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU35217Medicare UPIN