Provider Demographics
NPI:1184832917
Name:JUDGE, DANIEL KENAN (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:KENAN
Last Name:JUDGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16964 ROBBINS RD
Mailing Address - Street 2:SUITE 100 B
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2796
Mailing Address - Country:US
Mailing Address - Phone:616-935-7599
Mailing Address - Fax:616-935-7598
Practice Address - Street 1:16964 ROBBINS RD
Practice Address - Street 2:SUITE 100 B
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2796
Practice Address - Country:US
Practice Address - Phone:616-935-7599
Practice Address - Fax:616-935-7598
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDJ002540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor