Provider Demographics
NPI:1548476716
Name:COVINGTON SPINE CENTER, INC.
Entity type:Organization
Organization Name:COVINGTON SPINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:334-428-2225
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1200
Mailing Address - Country:US
Mailing Address - Phone:334-428-2225
Mailing Address - Fax:334-428-2222
Practice Address - Street 1:305 S THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-4427
Practice Address - Country:US
Practice Address - Phone:334-428-2225
Practice Address - Fax:334-428-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL 1919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51003674OtherBCBS OF ALABAMA
ALU75318Medicare UPIN