Provider Demographics
NPI:1558310532
Name:JULIAN, KEVIN C (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:JULIAN
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 1:318 SIP AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-6511
Mailing Address - Country:US
Mailing Address - Phone:201-333-7395
Mailing Address - Fax:201-333-6746
Practice Address - Street 1:318 SIP AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-6511
Practice Address - Country:US
Practice Address - Phone:201-333-7395
Practice Address - Fax:201-333-6746
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00282600111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1044231OtherHORIZON MERCY
NJ465800OtherAETNA
NJP643902OtherOXFORD HEALTHCARE
NJ1044231OtherHORIZON MERCY