Provider Demographics
NPI:1447335203
Name:KEVANIAN, HAROLD H (DC)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:H
Last Name:KEVANIAN
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 1:101 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059
Mailing Address - Country:US
Mailing Address - Phone:908-561-2323
Mailing Address - Fax:908-561-3434
Practice Address - Street 1:101 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE 115
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059
Practice Address - Country:US
Practice Address - Phone:908-561-2323
Practice Address - Fax:908-561-3434
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00441700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5375143OtherAETNA
NJKE754383Medicare PIN
U48436Medicare UPIN