Provider Demographics
NPI:1619905908
Name:JUDSON, STEPHEN CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CRAIG
Last Name:JUDSON
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 1:2434 BERLIN TPKE
Mailing Address - Street 2:UNIT 22
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4121
Mailing Address - Country:US
Mailing Address - Phone:860-667-3636
Mailing Address - Fax:860-667-3868
Practice Address - Street 1:2434 BERLIN TPKE
Practice Address - Street 2:UNIT 22
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4121
Practice Address - Country:US
Practice Address - Phone:860-667-3636
Practice Address - Fax:860-667-3868
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor