Provider Demographics
NPI:1851623698
Name:ARCHIBALD, JULIE C (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:C
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 PLEASANT ST UNIT 111
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2458
Mailing Address - Country:US
Mailing Address - Phone:585-750-0682
Mailing Address - Fax:
Practice Address - Street 1:311 E 78TH ST
Practice Address - Street 2:APT 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1366
Practice Address - Country:US
Practice Address - Phone:585-750-0682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2024-04-05
Deactivation Date:2024-03-28
Deactivation Code:
Reactivation Date:2024-04-03
Provider Licenses
StateLicense IDTaxonomies
NY011962111N00000X
MARN2300451363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No111N00000XChiropractic ProvidersChiropractor