Provider Demographics
NPI:1306274436
Name:NOVELLI WELLNESS CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:NOVELLI WELLNESS CHIROPRACTIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOVELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-713-0464
Mailing Address - Street 1:3045 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1209
Mailing Address - Country:US
Mailing Address - Phone:716-713-0464
Mailing Address - Fax:
Practice Address - Street 1:3045 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1209
Practice Address - Country:US
Practice Address - Phone:716-713-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty