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General NPI Number Information
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NPI Number | 1366719163
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Entity Type | Individual
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Provider Name | MATTHEW J KOVACH MD, DC
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Gender | Male
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 1300 W 13TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-1975
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Country | US
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Telephone | 719-544-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 W 13TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-1975
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Country | US
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Telephone | 719-544-4800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X009427
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | DR.0067225
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License Number State | CO
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