Provider Demographics
NPI:1568440626
Name:JUDGE, MICHAEL K (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
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 1:22 WASHINGTON AVE W
Mailing Address - Street 2:
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531-2030
Mailing Address - Country:US
Mailing Address - Phone:641-932-5157
Mailing Address - Fax:641-932-3211
Practice Address - Street 1:22 WASHINGTON AVE W
Practice Address - Street 2:
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531-2030
Practice Address - Country:US
Practice Address - Phone:641-932-5157
Practice Address - Fax:641-932-3211
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-08
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0269837Medicaid
IA26983Medicare PIN