Provider Demographics
NPI:1396894085
Name:NOVAK, MICHAEL EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:NOVAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4361 HIGHWAY 13 W
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-1479
Mailing Address - Country:US
Mailing Address - Phone:952-895-1120
Mailing Address - Fax:952-895-5377
Practice Address - Street 1:3701 HIGHWAY 13 W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1721
Practice Address - Country:US
Practice Address - Phone:952-895-1120
Practice Address - Fax:952-895-5377
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN35000218Medicare ID - Type Unspecified
MN79936Medicare UPIN