Healthcare Provider Details

I. General information

NPI: 1558310532
Provider Name (Legal Business Name): KEVIN C JULIAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 SIP AVE
JERSEY CITY NJ
07306-6511
US

IV. Provider business mailing address

318 SIP AVE
JERSEY CITY NJ
07306-6511
US

V. Phone/Fax

Practice location:
  • Phone: 201-333-7395
  • Fax: 201-333-6746
Mailing address:
  • Phone: 201-333-7395
  • Fax: 201-333-6746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00282600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: