Provider Demographics
NPI:1316167869
Name:KISELEV, YULIA (DC)
Entity type:Individual
Prefix:MRS
First Name:YULIA
Middle Name:
Last Name:KISELEV
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 DRISCOLL PL
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-4056
Mailing Address - Country:US
Mailing Address - Phone:650-856-8849
Mailing Address - Fax:650-856-8849
Practice Address - Street 1:4962 EL CAMINO REAL
Practice Address - Street 2:STE. 204
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1454
Practice Address - Country:US
Practice Address - Phone:650-210-8981
Practice Address - Fax:650-210-0070
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0264220OtherTIN IDENTIFICATION NUMBER