Provider Demographics
NPI:1063423739
Name:NOWICKI, JEFFREY B (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
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 1:2211 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4108
Mailing Address - Country:US
Mailing Address - Phone:714-774-2455
Mailing Address - Fax:714-774-1884
Practice Address - Street 1:2211 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4108
Practice Address - Country:US
Practice Address - Phone:714-774-2455
Practice Address - Fax:714-774-1884
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05088Medicare UPIN
CADC13630Medicare ID - Type Unspecified