Provider Demographics
NPI:1336221944
Name:NOWICKI, JOHN E (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:NOWICKI
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:W8065 S US HIGHWAY 2/141
Mailing Address - Street 2:SUITE 1
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-9494
Mailing Address - Country:US
Mailing Address - Phone:906-779-1300
Mailing Address - Fax:906-779-1333
Practice Address - Street 1:W8065 S US HIGHWAY 2/141
Practice Address - Street 2:SUITE 1
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-9494
Practice Address - Country:US
Practice Address - Phone:906-779-1300
Practice Address - Fax:906-779-1333
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38844000Medicaid
MI4217348Medicaid
MIMI367001Medicare UPIN
MI4217348Medicaid