Provider Demographics
NPI:1366719163
Name:KOVACH, MATTHEW J (MD, DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:KOVACH
Suffix:
Gender:M
Credentials:MD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-1975
Mailing Address - Country:US
Mailing Address - Phone:719-544-4800
Mailing Address - Fax:
Practice Address - Street 1:1300 W 13TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-1975
Practice Address - Country:US
Practice Address - Phone:719-544-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009427111N00000X
CODR.0067225208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC09427-8OtherWORKERS' COMPENSATION