Provider Demographics
NPI:1811171820
Name:KELIAN FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:KELIAN FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-505-8360
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-0019
Mailing Address - Country:US
Mailing Address - Phone:516-505-8360
Mailing Address - Fax:516-505-1008
Practice Address - Street 1:5 NASSAU BOULEVARD SOUTH
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-505-8360
Practice Address - Fax:516-505-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXQPX1Medicare UPIN