Organization
RICHARD M. NOVAK, DC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD MICHAEL NOVAK D.C. (PRESIDENT / OWNER)
(618) 288-8075
Entity
Organization
Contact information
Practice address
4A OAK DR, MARYVILLE, IL 62062-5809
(618) 288-8075
Mailing address
4A OAK DR, MARYVILLE, IL 62062-5809
(618) 288-8075
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209673
MEDICARE
IL
01
—
37-1395118
TAX ID
IL
01
—
DG4136
RAILROAD MEDICARE
IL
Enumeration date
01/09/2007
Last updated
08/05/2008
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