Provider Demographics
NPI:1912045949
Name:KOVACH, JENNIFER (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:KOVACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 NEW SALEM ROAD
Mailing Address - Street 2:PO BOX 777
Mailing Address - City:REPUBLIC
Mailing Address - State:PA
Mailing Address - Zip Code:15475
Mailing Address - Country:US
Mailing Address - Phone:724-245-1614
Mailing Address - Fax:724-245-1616
Practice Address - Street 1:1614 NEW SALEM ROAD
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:PA
Practice Address - Zip Code:15475
Practice Address - Country:US
Practice Address - Phone:724-245-1614
Practice Address - Fax:724-245-1616
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007928-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor