Healthcare Provider Details

I. General information

NPI: 1003052838
Provider Name (Legal Business Name): RYAN NOVAK D.C., N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 E 63RD PL STE 300
TULSA OK
74133-1202
US

IV. Provider business mailing address

7633 E 63RD PL STE 300
TULSA OK
74133-1202
US

V. Phone/Fax

Practice location:
  • Phone: 918-732-9677
  • Fax:
Mailing address:
  • Phone: 918-732-9677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number4206
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: