Provider Demographics
NPI:1164510699
Name:TRUDEAU, JULIA W (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:W
Last Name:TRUDEAU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 VOLVO PKWY
Mailing Address - Street 2:STE 118
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2811
Mailing Address - Country:US
Mailing Address - Phone:757-469-6677
Mailing Address - Fax:757-436-6789
Practice Address - Street 1:801 VOLVO PKWY
Practice Address - Street 2:STE 118
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2811
Practice Address - Country:US
Practice Address - Phone:757-469-6677
Practice Address - Fax:757-436-6789
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01040001183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA073646OtherANTHEM BCBS
VA9526633Medicaid
VA073646OtherANTHEM BCBS