Healthcare Provider Details

I. General information

NPI: 1790195774
Provider Name (Legal Business Name): NICHOLAS NOVAKOSKI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2014
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:
Title or Position:
Credential:
Phone: