Provider Demographics
NPI:1427593375
Name:COVENANT INTEGRATIVE WELLNESS, LLC
Entity Type:Organization
Organization Name:COVENANT INTEGRATIVE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:O'DONNELL
Authorized Official - Last Name:MCGOWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-898-6939
Mailing Address - Street 1:1022 NORTHEAST DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2513
Mailing Address - Country:US
Mailing Address - Phone:816-898-6939
Mailing Address - Fax:
Practice Address - Street 1:1022 NORTHEAST DR
Practice Address - Street 2:SUITE B
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2513
Practice Address - Country:US
Practice Address - Phone:816-898-6939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011000683111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty