Provider Demographics
NPI:1093735904
Name:SOLARI, KEVIN AUGUST (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:AUGUST
Last Name:SOLARI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9122 N ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-9409
Mailing Address - Country:US
Mailing Address - Phone:209-607-1078
Mailing Address - Fax:
Practice Address - Street 1:2904 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3638
Practice Address - Country:US
Practice Address - Phone:209-948-1860
Practice Address - Fax:209-943-0243
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0302100Medicare UPIN