Provider Demographics
NPI:1639179625
Name:ST. CLAIR, JUDITH ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:ST. CLAIR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-4142
Mailing Address - Country:US
Mailing Address - Phone:612-869-7371
Mailing Address - Fax:612-869-2761
Practice Address - Street 1:7400 LYNDALE AVE S
Practice Address - Street 2:#190
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-4055
Practice Address - Country:US
Practice Address - Phone:612-869-7371
Practice Address - Fax:612-869-2761
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN16712CLOtherBCBSM ID
MN44 48356OtherMEDICA PROVIDER ID
MN88651OtherHEALTH PARTNERS UPIN (COR
MN1C007STOtherBCBSM INDIV. PROV. ID
MN230823OtherCHIROCARE ID
MN230823OtherCHIROCARE ID