Provider Demographics
NPI:1972790616
Name:COVINGTON CHIROPRACTIC INC
Entity type:Organization
Organization Name:COVINGTON CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:STICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-962-0809
Mailing Address - Street 1:222 N COURT AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1536
Mailing Address - Country:US
Mailing Address - Phone:540-962-0809
Mailing Address - Fax:
Practice Address - Street 1:222 N COURT AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1536
Practice Address - Country:US
Practice Address - Phone:540-962-0809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08767Medicare PIN