Provider Demographics
NPI:1396051371
Name:DR. DONNIE NOVAK LLC
Entity type:Organization
Organization Name:DR. DONNIE NOVAK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-984-7839
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:PA
Mailing Address - Zip Code:15344-0211
Mailing Address - Country:US
Mailing Address - Phone:724-883-3733
Mailing Address - Fax:724-883-4766
Practice Address - Street 1:1412 JEFFERSON ROAD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:PA
Practice Address - Zip Code:15344
Practice Address - Country:US
Practice Address - Phone:724-883-3733
Practice Address - Fax:724-883-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV720936 62Z642OtherACN GROUP
WV1770768632OtherMOUNTAIN STATE BLUE CROSS BLUE SHIELD
WVWV878OtherHEALTH PLAN OF WEST VIRGINIA
WV3810012422Medicaid
4841943OtherCIGNA
WV9211153OtherAETNA
WVWV878OtherHEALTH PLAN OF WEST VIRGINIA