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General NPI Number Information
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NPI Number | 1508098062
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Entity Type | Organization
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Legal Business Name | COVINGTON CHIROPRACTIC & REHAB CENTER
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 200 W PIKE ST
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City | COVINGTON
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State | KY
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Zip | 41011-2370
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Country | US
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Telephone | 859-360-6488
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Fax | 859-360-6264
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Provider Business Mailing Address
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Address Line | 200 W PIKE ST
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City | COVINGTON
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State | KY
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Zip | 41011-2370
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Country | US
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Telephone | 859-360-6488
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Fax | 859-360-6264
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN W JOHNSON
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Credential | D.C.
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Telephone | 859-360-6488
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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 | 4110
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License Number State | KY
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