Provider Demographics
NPI:1649721275
Name:CHRISTIAN, PAUL KEVIN (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:KEVIN
Last Name:CHRISTIAN
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 1:2309 W DR.MARTIN LUTHER KING JR. BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-4034
Mailing Address - Country:US
Mailing Address - Phone:813-677-2633
Mailing Address - Fax:813-930-5963
Practice Address - Street 1:2309 W DR.MARTIN LUTHER KING JR. BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-4034
Practice Address - Country:US
Practice Address - Phone:813-677-2633
Practice Address - Fax:813-930-5963
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5756111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology