Provider Demographics
NPI:1447312228
Name:NOVICK, LAURENCE RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:RICHARD
Last Name:NOVICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 S UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-434-2225
Mailing Address - Fax:954-434-2228
Practice Address - Street 1:4801 S UNIVERSITY DR
Practice Address - Street 2:SUITE 107
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3839
Practice Address - Country:US
Practice Address - Phone:954-434-2225
Practice Address - Fax:954-434-2228
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70604Medicare ID - Type Unspecified