Provider Demographics
NPI:1295889780
Name:NOVAK, CARISA SUSUNNA ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:CARISA
Middle Name:SUSUNNA ELIZABETH
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1100 W GONZALES RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-3336
Mailing Address - Country:US
Mailing Address - Phone:805-485-4339
Mailing Address - Fax:805-485-6042
Practice Address - Street 1:1100 W GONZALES RD
Practice Address - Street 2:SUITE #101
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3336
Practice Address - Country:US
Practice Address - Phone:805-485-4339
Practice Address - Fax:805-485-6042
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC 26348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor