MEDICARE: THOMAS J KOVACS JR DC LLC

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	CH 9010	FL

General Provider Information

NPI Number	:	1811172430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS J KOVACS JR DC LLC

Provider Business Mailing Address
First Line	:	212 MOODY BLVD
Second Line	:
City	:	FLAGLER BEACH
State	:	FL
Zip	:	32136-3372
Country	:	US
Telephone Number	:	386-527-2955
Fax Number	:	386-439-0002

Provider Business Practice Location Address
First Line	:	212 MOODY BLVD
Second Line	:
City	:	FLAGLER BEACH
State	:	FL
Zip	:	32136-3372
Country	:	US
Telephone Number	:	386-439-0005
Fax Number	:	386-439-0002

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS J KOVACS JR.
Credential	:	D.C.
Telephone Number	:	386-439-0005

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	04/29/2008

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