Provider Demographics
NPI:1063530319
Name:JIMENEZ, JULIO (DC)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:JIMENEZ
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 1:2330 N KANSAS AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2372
Mailing Address - Country:US
Mailing Address - Phone:620-624-7773
Mailing Address - Fax:620-626-7396
Practice Address - Street 1:2330 N KANSAS AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2372
Practice Address - Country:US
Practice Address - Phone:620-624-7773
Practice Address - Fax:620-626-7396
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660035OtherBCBS OF KANSAS
KS660035OtherBCBS OF KANSAS
KS062047Medicare ID - Type Unspecified