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General NPI Number Information
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NPI Number | 1972790616
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Entity Type | Organization
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Legal Business Name | COVINGTON CHIROPRACTIC INC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 222 N COURT AVE
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City | COVINGTON
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State | VA
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Zip | 24426-1536
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Country | US
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Telephone | 540-962-0809
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Fax |
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Provider Business Mailing Address
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Address Line | 222 N COURT AVE
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City | COVINGTON
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State | VA
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Zip | 24426-1536
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Country | US
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Telephone | 540-962-0809
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRAVIS N STICKLE
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Credential | DC
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Telephone | 540-962-0809
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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 | 0104555954
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License Number State | VA
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