Provider Demographics
NPI:1538400031
Name:COVINGTON CHIROPRACTIC LLC
Entity type:Organization
Organization Name:COVINGTON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:BOOHER
Authorized Official - Last Name:VITALIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-630-9777
Mailing Address - Street 1:26708 180TH AVE SE
Mailing Address - Street 2:SUITE102
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4969
Mailing Address - Country:US
Mailing Address - Phone:253-630-9777
Mailing Address - Fax:253-630-9806
Practice Address - Street 1:26708 180TH AVE SE
Practice Address - Street 2:SUITE102
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4969
Practice Address - Country:US
Practice Address - Phone:253-630-9777
Practice Address - Fax:253-630-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002179261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000109628Medicare UPIN