Healthcare Provider Details

I. General information

NPI: 1164973863
Provider Name (Legal Business Name): NOVA CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CATALPA DR
ROYAL OAK MI
48067-1242
US

IV. Provider business mailing address

116 CATALPA DR
ROYAL OAK MI
48067-1242
US

V. Phone/Fax

Practice location:
  • Phone: 248-398-1155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010249
License Number StateMI

VIII. Authorized Official

Name: NICHOLAS NOVAKOSKI
Title or Position: OWNER
Credential: DC
Phone: 248-398-1155