Provider Demographics
NPI:1699288696
Name:KEBABJIAN, ISAAC GARRETT (DC)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:GARRETT
Last Name:KEBABJIAN
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 1:62 STRANGEWAY TER
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3844
Mailing Address - Country:US
Mailing Address - Phone:862-256-0353
Mailing Address - Fax:
Practice Address - Street 1:62 STRANGEWAY TER
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3844
Practice Address - Country:US
Practice Address - Phone:862-256-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00749200111N00000X
IN08003109A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty