MEDICARE: TIMOTHY P NOVELLI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1154	OH

General Provider Information

NPI Number	:	1104928415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY P NOVELLI D.C.

Provider Business Mailing Address
First Line	:	525 N MAIN ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2566
Country	:	US
Telephone Number	:	330-497-1942
Fax Number	:	330-497-0619

Provider Business Practice Location Address
First Line	:	525 N MAIN ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2566
Country	:	US
Telephone Number	:	330-497-1942
Fax Number	:	330-497-0619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/08/2007

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