Provider Demographics
NPI:1902046741
Name:NOVAK, KATHLEEN A'HEARN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A'HEARN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17830 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-6169
Mailing Address - Country:US
Mailing Address - Phone:815-260-3801
Mailing Address - Fax:815-717-6292
Practice Address - Street 1:2531 DIVISION ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8734
Practice Address - Country:US
Practice Address - Phone:815-744-4010
Practice Address - Fax:815-744-4888
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor