Provider Demographics
NPI:1598878589
Name:JUDGE, JODI L (DC DACNB CCN)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:JUDGE
Suffix:
Gender:F
Credentials:DC DACNB CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14155 N 83RD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5640
Mailing Address - Country:US
Mailing Address - Phone:623-878-0475
Mailing Address - Fax:623-878-0640
Practice Address - Street 1:14155 N 83RD AVE STE 102
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5640
Practice Address - Country:US
Practice Address - Phone:623-878-0475
Practice Address - Fax:623-878-0640
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ-5016111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition