MEDICARE: DR. JEFFREY CARL COVAULT 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	4138	OH

General Provider Information

NPI Number	:	1760714455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY CARL COVAULT D.C.

Provider Business Mailing Address
First Line	:	789 CITY PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-2048
Country	:	US
Telephone Number	:	740-706-1760
Fax Number	:

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	:	614-878-3521

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

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	11/23/2020

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