Provider Demographics
NPI:1699191288
Name:NOVAK, SHANDA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANDA
Middle Name:LYNN
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 37
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-0037
Mailing Address - Country:US
Mailing Address - Phone:276-889-1314
Mailing Address - Fax:276-889-4125
Practice Address - Street 1:619 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-3809
Practice Address - Country:US
Practice Address - Phone:276-889-1314
Practice Address - Fax:276-889-4125
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor