Healthcare Provider Details

I. General information

NPI: 1851468995
Provider Name (Legal Business Name): CHARLES VINCENT JUDGE III DOCTOR OF CHIROPRACT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 POST OFFICE RD SUITE 104
WALDORF MD
20602
US

IV. Provider business mailing address

3 POST OFFICE RD SUITE 104
WALDORF MD
20602-2756
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-5393
  • Fax: 301-645-9490
Mailing address:
  • Phone: 301-645-5393
  • Fax: 301-645-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01688
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01688
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: