MEDICARE: DR. KALIE ELIZABETH JUDGE D.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	038011804	IL

General Provider Information

NPI Number	:	1427352608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALIE ELIZABETH JUDGE D.C.

Provider Business Mailing Address
First Line	:	2422 W MAIN ST
Second Line	:
City	:	SAINT CHARLES
State	:	IL
Zip	:	60175-1010
Country	:	US
Telephone Number	:	630-377-3500
Fax Number	:	630-377-3553

Provider Business Practice Location Address
First Line	:	2422 W MAIN ST
Second Line	:
City	:	SAINT CHARLES
State	:	IL
Zip	:	60175-1010
Country	:	US
Telephone Number	:	630-377-3500
Fax Number	:	630-377-3553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2011
Last Update Date	:	01/03/2011

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