Provider Demographics
NPI:1184601676
Name:NOWAK, EDWARD MICHAEL (DC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MICHAEL
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:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-0337
Mailing Address - Country:US
Mailing Address - Phone:413-584-8976
Mailing Address - Fax:413-584-7354
Practice Address - Street 1:190 RUSSELL STREET
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9542
Practice Address - Country:US
Practice Address - Phone:413-584-8976
Practice Address - Fax:413-584-7354
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1604678Medicaid
Y35048OtherBLUE SHIELD OF MA
P00172510OtherRAILROAD MEDICARE
0004361700OtherAETNA
798574OtherTUFTS
MA351055OtherHARVARD PILGRIM
T57970Medicare UPIN
MA351055OtherHARVARD PILGRIM