Provider Demographics
NPI:1255503967
Name:DR. JOHN F. KOVATCH D.C. LLC
Entity Type:Organization
Organization Name:DR. JOHN F. KOVATCH D.C. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KOVATCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-870-7300
Mailing Address - Street 1:4760 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1613
Mailing Address - Country:US
Mailing Address - Phone:614-870-7300
Mailing Address - Fax:614-870-7341
Practice Address - Street 1:4760 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1613
Practice Address - Country:US
Practice Address - Phone:614-870-7300
Practice Address - Fax:614-870-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9356551Medicare PIN