Provider Demographics
NPI:1699191288
Name:NOVAK, SHANDA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:SHANDA
Middle Name:LYNN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1453
Mailing Address - Country:US
Mailing Address - Phone:319-396-2300
Mailing Address - Fax:
Practice Address - Street 1:3221 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1453
Practice Address - Country:US
Practice Address - Phone:319-396-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2820111N00000X
IA119777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor