Provider Demographics
NPI:1619169448
Name:JUDGE, JESSICA RAECHELLE (DC, BS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RAECHELLE
Last Name:JUDGE
Suffix:
Gender:F
Credentials:DC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 77033
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-0033
Mailing Address - Country:US
Mailing Address - Phone:940-648-1700
Mailing Address - Fax:
Practice Address - Street 1:112 W. 4TH ST
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247
Practice Address - Country:US
Practice Address - Phone:940-648-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608411OtherBCBS
TXB103053Medicare PIN
TX613299Medicare PIN