MEDICARE: DR. JUDITH W BOOTHBY DC

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	272207	OR

General Provider Information

NPI Number	:	1942412283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH W BOOTHBY DC

Provider Business Mailing Address
First Line	:	1620 SE ANKENY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1448
Country	:	US
Telephone Number	:	503-233-0943
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 SE ANKENY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1448
Country	:	US
Telephone Number	:	503-233-0943
Fax Number	:	503-233-0943

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	05/13/2010

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