Provider Demographics
NPI:1780678557
Name:NOWAK, EDWARD PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PETER
Last Name:NOWAK
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 1:16 SPRINGPOINT RD
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95012-9723
Mailing Address - Country:US
Mailing Address - Phone:831-633-3810
Mailing Address - Fax:831-663-8807
Practice Address - Street 1:909 E ALISAL ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2607
Practice Address - Country:US
Practice Address - Phone:831-422-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0248290Medicare ID - Type Unspecified