MEDICARE: KEVIN C JULIAN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	38MC00282600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1044231	OTHER	NJ	HORIZON MERCY
2	465800	OTHER	NJ	AETNA
3	P643902	OTHER	NJ	OXFORD HEALTHCARE

General Provider Information

NPI Number	:	1558310532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN C JULIAN DC

Provider Business Mailing Address
First Line	:	318 SIP AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-6511
Country	:	US
Telephone Number	:	201-333-7395
Fax Number	:	201-333-6746

Provider Business Practice Location Address
First Line	:	318 SIP AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-6511
Country	:	US
Telephone Number	:	201-333-7395
Fax Number	:	201-333-6746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	07/08/2007

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Directions to “ KEVIN C JULIAN DC” Practice Location

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