Provider Demographics
NPI:1104934207
Name:NOVAK CHIROPRACTIC CLINIC, P.A.
Entity type:Organization
Organization Name:NOVAK CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-788-7300
Mailing Address - Street 1:9535 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66111
Mailing Address - Country:US
Mailing Address - Phone:913-788-7300
Mailing Address - Fax:913-788-9679
Practice Address - Street 1:9535 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66111
Practice Address - Country:US
Practice Address - Phone:913-788-7300
Practice Address - Fax:913-788-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS14265014OtherBCBS KC
KS350077071OtherRAILROAD MEDICARE
KS350077071OtherRAILROAD MEDICARE