Provider Demographics
NPI:1770768632
Name:NOVAK, DONALD I (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:I
Last Name:NOVAK
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 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:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV878111N00000X
PADC010188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770768632OtherBLUE CROSS BLUE SHIELD