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General NPI Number Information
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NPI Number | 1811172430
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Entity Type | Organization
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Legal Business Name | THOMAS J KOVACS JR DC LLC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 212 MOODY BLVD
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3372
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Country | US
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Telephone | 386-439-0005
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Fax | 386-439-0002
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Provider Business Mailing Address
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Address Line | 212 MOODY BLVD
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3372
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Country | US
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Telephone | 386-527-2955
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Fax | 386-439-0002
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS J KOVACS JR.
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Credential | D.C.
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Telephone | 386-439-0005
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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 | CH 9010
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License Number State | FL
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