Provider Demographics
NPI:1467601054
Name:COVERDILL, JENNIFER R (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:COVERDILL
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 1:4903 S BECKER DR
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61607-2848
Mailing Address - Country:US
Mailing Address - Phone:309-697-9617
Mailing Address - Fax:309-697-9117
Practice Address - Street 1:4903 S BECKER DR
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:IL
Practice Address - Zip Code:61607-2848
Practice Address - Country:US
Practice Address - Phone:309-697-9617
Practice Address - Fax:309-697-9117
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor