MEDICARE: DR. KATHERINE MARIE COVAULT DC

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	X011959	NY
2	111N00000X	Chiropractor	4140	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255663456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE MARIE COVAULT DC

Provider Business Mailing Address
First Line	:	4810 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1602
Country	:	US
Telephone Number	:	614-878-3533
Fax Number	:	866-713-4492

Provider Business Practice Location Address
First Line	:	4810 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1602
Country	:	US
Telephone Number	:	614-878-3533
Fax Number	:	866-713-4492

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

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	11/21/2020

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