Provider Demographics
NPI:1821094699
Name:KOVACIC, JEFFREY M (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:KOVACIC
Suffix:
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 1:1384 VERA DR
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9823
Mailing Address - Country:US
Mailing Address - Phone:517-437-4767
Mailing Address - Fax:517-437-0567
Practice Address - Street 1:1384 VERA DR
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9823
Practice Address - Country:US
Practice Address - Phone:517-437-4767
Practice Address - Fax:517-437-0567
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJK005923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00643696OtherPALMETTO RAILROAD GBA
MI1174771745OtherTYPE II NPI
MI262968470OtherCOFINITY
MI2650090OtherCIGNA PPO
MI950C000040OtherBLUE CARE NETWORK
MI5843475OtherAETNA
MI950C000040OtherINDIVIDUAL BCBSM PIN
MIP62590003Medicare PIN
MI262968470OtherCOFINITY