=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265621122
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COVENY CHIROPRACTIC CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2007
-----------------------------------------------------
Last Update Date | 10/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 SOUTH TAYLOR STREET
-----------------------------------------------------
City | HOLMESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-279-2225
-----------------------------------------------------
Fax | 330-279-2220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 SOUTH TAYLOR STREET
-----------------------------------------------------
City | HOLMESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-279-2225
-----------------------------------------------------
Fax | 330-279-2220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RACHEL MARIE COVENY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 330-279-2225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3055
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------