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General NPI Number Information
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NPI Number | 1508166844
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Entity Type | Individual
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Provider Name | TIMOTHY GERARD NOVICKY DC
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Gender | Male
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 8098 E MARKET ST SUITE #2
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City | WARREN
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State | OH
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Zip | 44484-2270
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Country | US
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Telephone | 330-717-3550
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Fax | 330-617-4270
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Provider Business Mailing Address
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Address Line | 8098 E MARKET ST SUITE #2
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City | WARREN
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State | OH
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Zip | 44484-2270
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Country | US
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Telephone | 330-717-3550
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Fax | 330-617-4270
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4064
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License Number State | OH
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