Provider Demographics
NPI:1942911607
Name:COVENANT PEDIATRICS, LLC
Entity Type:Organization
Organization Name:COVENANT PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-635-6217
Mailing Address - Street 1:2409 HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-4732
Mailing Address - Country:US
Mailing Address - Phone:573-635-6217
Mailing Address - Fax:573-635-6574
Practice Address - Street 1:2409 HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-4732
Practice Address - Country:US
Practice Address - Phone:573-635-6217
Practice Address - Fax:573-635-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service