=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295951242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTIN L. NOVAK, D.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 06/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 527 SHADY AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15206-4437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-661-5000
-----------------------------------------------------
Fax | 412-661-4192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 527 SHADY AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15206-4437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-661-5000
-----------------------------------------------------
Fax | 412-661-4192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARTIN LOUIS NOVAK
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 412-661-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC004531L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------