Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038011278 | IL |
NPI | 1003052838 |
---|---|
Provider Name | Dr. Ryan Daniel Novak |
First Address | Hickory Hills, IL 60457-2133 |
Second Address | Hickory Hills, IL 60457-2133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2008 |
Last Update Date | 29/12/2008 |