Provider Demographics
NPI:1447540588
Name:NOVICK CHIROPRACTIC P A
Entity type:Organization
Organization Name:NOVICK CHIROPRACTIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-434-2225
Mailing Address - Street 1:4801 SOUTH UNIVERSITY DRIVE SUITE 107
Mailing Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty