Provider Demographics
NPI:1598950800
Name:COVERT, KENDALL N JR (DC)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:N
Last Name:COVERT
Suffix:JR
Gender:M
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:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-0214
Mailing Address - Country:US
Mailing Address - Phone:360-887-2135
Mailing Address - Fax:360-887-2984
Practice Address - Street 1:414 PIONEER ST STE 102
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-4512
Practice Address - Country:US
Practice Address - Phone:360-887-2135
Practice Address - Fax:360-887-2984
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA224341OtherDEPARTMENT OF LABOR & INDUSTRIES