Provider Demographics
NPI:1952436511
Name:KULIK, KEVIN K (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:K
Last Name:KULIK
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 1:1121 NO BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NO MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1341
Mailing Address - Country:US
Mailing Address - Phone:516-454-0400
Mailing Address - Fax:516-454-0406
Practice Address - Street 1:1121 NO BROADWAY
Practice Address - Street 2:
Practice Address - City:NO MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1341
Practice Address - Country:US
Practice Address - Phone:516-454-0400
Practice Address - Fax:516-454-0406
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002975-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX17651Medicare PIN
T52326Medicare UPIN