Provider Demographics
NPI:1922137496
Name:NOVICKIS, RIMAS LEO (D C)
Entity Type:Individual
Prefix:DR
First Name:RIMAS
Middle Name:LEO
Last Name:NOVICKIS
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3128
Mailing Address - Country:US
Mailing Address - Phone:708-484-1111
Mailing Address - Fax:708-484-1112
Practice Address - Street 1:6645 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3128
Practice Address - Country:US
Practice Address - Phone:708-484-1111
Practice Address - Fax:708-484-1112
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor