MEDICARE: DR. BROOKS COVILLE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2193	GA

General Provider Information

NPI Number	:	1093939019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BROOKS COVILLE D.C.

Provider Business Mailing Address
First Line	:	8 QUAIL HOLW SE
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-6820
Country	:	US
Telephone Number	:	706-295-1109
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 MARTHA BERRY BLVD NW
Second Line	:	SUITE B
City	:	ROME
State	:	GA
Zip	:	30165-1621
Country	:	US
Telephone Number	:	706-235-6467
Fax Number	:	706-235-0449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. BROOKS COVILLE D.C.” Practice Location

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