Healthcare Provider Details

I. General information

NPI: 1104993252
Provider Name (Legal Business Name): JOHN COVILLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 CABOT ST
BEVERLY MA
01915-5822
US

IV. Provider business mailing address

81 OCEAN ST
LYNN MA
01902-2048
US

V. Phone/Fax

Practice location:
  • Phone: 978-524-4888
  • Fax:
Mailing address:
  • Phone: 781-598-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number475
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: