Provider Demographics
NPI:1679625768
Name:NOVICKY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:NOVICKY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NOVICKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACRB, CIME
Authorized Official - Phone:330-759-9912
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:
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:990-759-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2138111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2138OtherLICENSE
OH0744682Medicare ID - Type UnspecifiedMEDICARE