Provider Demographics
NPI:1912295460
Name:CHIROPRACTIC ASSOCIATES OF NEW
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF NEW
Other - Org Name:COLUMBUS CHIROPRACTIC CENTER WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:COVAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-706-1760
Mailing Address - Street 1:4810 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1602
Mailing Address - Country:US
Mailing Address - Phone:614-878-3533
Mailing Address - Fax:866-713-4492
Practice Address - Street 1:4810 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1602
Practice Address - Country:US
Practice Address - Phone:614-878-3533
Practice Address - Fax:614-878-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0051933Medicaid
OH0051933Medicaid