Provider Demographics
NPI:1942237102
Name:KOVARA, BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:KOVARA
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 1:363 TORMEY LN NE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2895
Mailing Address - Country:US
Mailing Address - Phone:206-842-4929
Mailing Address - Fax:206-842-4920
Practice Address - Street 1:363 TORMEY LN NE
Practice Address - Street 2:SUITE 210
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2895
Practice Address - Country:US
Practice Address - Phone:206-842-4929
Practice Address - Fax:206-842-4920
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3792-012111N00000X
WACH60503164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38933700Medicaid
WI38933700Medicaid
WI000935600Medicare ID - Type Unspecified