Provider Demographics
NPI:1255663456
Name:COVAULT, KATHERINE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARIE
Last Name:COVAULT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1602
Mailing Address - Country:US
Mailing Address - Phone:614-878-3533
Mailing Address - Fax:866-713-4492
Practice Address - Street 1:4810 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1602
Practice Address - Country:US
Practice Address - Phone:614-878-3533
Practice Address - Fax:866-713-4492
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011959111N00000X
OH4140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0051999Medicaid