Healthcare Provider Details

I. General information

NPI: 1801084777
Provider Name (Legal Business Name): STEPHEN P. NOHAVA DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 GRANDSTAND PL
ELGIN IL
60123-4980
US

IV. Provider business mailing address

1795 GRANDSTAND PL
ELGIN IL
60123-4980
US

V. Phone/Fax

Practice location:
  • Phone: 847-888-3131
  • Fax: 847-888-3359
Mailing address:
  • Phone: 847-888-3131
  • Fax: 847-888-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.011217
License Number StateIL

VIII. Authorized Official

Name: DR. STEPHEN PAUL NOHAVA
Title or Position: PRESIDENT
Credential: D.C.
Phone: 847-888-3131