Provider Demographics
NPI:1619045895
Name:DR. JUDITH YAGER DC, INC.
Entity Type:Organization
Organization Name:DR. JUDITH YAGER DC, INC.
Other - Org Name:JUDITH A. YAGER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-623-3800
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:COBB
Mailing Address - State:WI
Mailing Address - Zip Code:53526-0125
Mailing Address - Country:US
Mailing Address - Phone:608-623-3800
Mailing Address - Fax:608-623-3802
Practice Address - Street 1:109 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:COBB
Practice Address - State:WI
Practice Address - Zip Code:53526
Practice Address - Country:US
Practice Address - Phone:608-623-3800
Practice Address - Fax:608-623-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3435-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========028OtherGROUP BC BS PIN