Provider Demographics
NPI:1396815197
Name:JUDD, BRADLEY MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:MICHAEL
Last Name:JUDD
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 1:5545 AVENIDA DEL TREN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-4903
Mailing Address - Country:US
Mailing Address - Phone:714-692-2371
Mailing Address - Fax:
Practice Address - Street 1:18256 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3411
Practice Address - Country:US
Practice Address - Phone:714-985-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC14651Medicare ID - Type Unspecified