MEDICARE: W L JUDGE CHIROPRACTIC CENTER P C

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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1639181118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W L JUDGE CHIROPRACTIC CENTER P C

Provider Business Mailing Address
First Line	:	6006 N 83RD AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-4119
Country	:	US
Telephone Number	:	623-872-9232
Fax Number	:

Provider Business Practice Location Address
First Line	:	6006 N 83RD AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-4119
Country	:	US
Telephone Number	:	623-872-9232
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAN JUDGE
Credential	:
Telephone Number	:	623-872-9232

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	11/30/2010

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