Provider Demographics
NPI:1427208511
Name:FITWELL CHIROPRACTIC SPORTS MEDICINE
Entity Type:Organization
Organization Name:FITWELL CHIROPRACTIC SPORTS MEDICINE
Other - Org Name:LISA COVEY, DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-920-9766
Mailing Address - Street 1:900 NOE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3309
Mailing Address - Country:US
Mailing Address - Phone:415-920-9766
Mailing Address - Fax:415-920-9767
Practice Address - Street 1:900 NOE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3309
Practice Address - Country:US
Practice Address - Phone:415-920-9766
Practice Address - Fax:415-920-9767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0270321Medicare PIN