Provider Demographics
NPI:1245390111
Name:DOUGAN, JUDITH (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:DOUGAN
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 1:8 ARNOLD DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1701
Mailing Address - Country:US
Mailing Address - Phone:845-679-0093
Mailing Address - Fax:845-331-1104
Practice Address - Street 1:400 KINGS MALL CT
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1578
Practice Address - Country:US
Practice Address - Phone:845-331-1103
Practice Address - Fax:845-331-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C085078BOtherWORKERS COMP
X5B972Medicare ID - Type Unspecified