Provider Demographics
NPI:1760685473
Name:NOVELLI, STEPHEN (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:NOVELLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 ORCHARD PARK RD # B
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4658
Mailing Address - Country:US
Mailing Address - Phone:716-573-6666
Mailing Address - Fax:
Practice Address - Street 1:3050 ORCHARD PARK RD # B
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4658
Practice Address - Country:US
Practice Address - Phone:716-573-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor