Active NPI
Richard M. Novak, DC PC
- Rehabilitation Chiropractor
- Maryville, IL
National Provider Identifier
1992854814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Chiropractor
- Legal business name
- RICHARD M. NOVAK, DC PC
- Practice address
- 4A Oak Dr
Maryville, IL 62062-5809 - Phone
- (618) 288-8075
- NPI assigned
- Jan 9, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Richard Michael Novak, D.C.
- Title
- President / Owner
- Phone
- (618) 288-8075
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Chiropractor | 111NR0400X | Primary |
Addresses
Primary practice location
4A Oak Dr
Maryville, IL 62062-5809
Mailing address
4A Oak Dr
Maryville, IL 62062-5809
Phone (618) 288-8075
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209673 | Other | IL | MEDICARE |
| DG4136 | Other | IL | RAILROAD MEDICARE |
| 37-1395118 | Other | IL | TAX ID |
National Provider Directory
National Provider DirectoryLocations
4 Oak Dr
Ste A
Maryville, IL 62062
Phone (618) 288-8075
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Chiropractor
- Shiloh, IL
- NPI 1477001634
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1217894400000",
"number": "1992854814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4A OAK DR",
"city": "MARYVILLE",
"state": "IL",
"postal_code": "620625809",
"telephone_number": "618-288-8075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4A OAK DR",
"city": "MARYVILLE",
"state": "IL",
"postal_code": "620625809",
"telephone_number": "618-288-8075"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RICHARD M. NOVAK, DC PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-09",
"last_updated": "2008-08-05",
"status": "A",
"authorized_official_last_name": "NOVAK",
"authorized_official_first_name": "RICHARD",
"authorized_official_middle_name": "MICHAEL",
"authorized_official_title_or_position": "PRESIDENT / OWNER",
"authorized_official_telephone_number": "618-288-8075",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.C."
},
"taxonomies": [
{
"code": "111NR0400X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Chiropractor, Rehabilitation",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "209673",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "DG4136",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "37-1395118",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maryville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.