Provider Demographics
NPI:1881203339
Name:JARED COVARRUBIAS CHIROPRACTIC
Entity Type:Organization
Organization Name:JARED COVARRUBIAS CHIROPRACTIC
Other - Org Name:COACH JARED INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:COVARRUBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-536-7420
Mailing Address - Street 1:4500 STEINER RANCH BLVD APT 910
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2313
Mailing Address - Country:US
Mailing Address - Phone:626-536-7420
Mailing Address - Fax:
Practice Address - Street 1:4500 STEINER RANCH BLVD APT 910
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2313
Practice Address - Country:US
Practice Address - Phone:626-536-7420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty