MEDICARE: J L JUDGE CHIROPRACTIC CENTER WEST PC

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	261Q00000X	Clinic/Center	ZDC5016	AZ

General Provider Information

NPI Number	:	1518166735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J L JUDGE CHIROPRACTIC CENTER WEST PC

Provider Business Mailing Address
First Line	:	14155 N 83RD AVE STE 102
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-5640
Country	:	US
Telephone Number	:	623-878-0475
Fax Number	:	623-878-0640

Provider Business Practice Location Address
First Line	:	14155 N 83RD AVE STE 102
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-5640
Country	:	US
Telephone Number	:	623-878-0475
Fax Number	:	623-878-0640

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. JODI L JUDGE
Credential	:	DC
Telephone Number	:	623-878-0475

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	09/06/2007

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