Provider Demographics
NPI:1285961821
Name:JOHN S KOVAR DC PA
Entity type:Organization
Organization Name:JOHN S KOVAR DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-244-1200
Mailing Address - Street 1:29G MIRACLE STRIP PKWY SW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-6655
Mailing Address - Country:US
Mailing Address - Phone:850-244-1200
Mailing Address - Fax:850-664-2170
Practice Address - Street 1:29G MIRACLE STRIP PKWY SW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-6655
Practice Address - Country:US
Practice Address - Phone:850-244-1200
Practice Address - Fax:850-664-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T55975Medicare UPIN
FL88814Medicare PIN