Provider Demographics
NPI:1104928415
Name:NOVELLI, TIMOTHY P (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:NOVELLI
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 1:525 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2566
Mailing Address - Country:US
Mailing Address - Phone:330-497-1942
Mailing Address - Fax:330-497-0619
Practice Address - Street 1:525 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2566
Practice Address - Country:US
Practice Address - Phone:330-497-1942
Practice Address - Fax:330-497-0619
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor