Provider Demographics
NPI:1740220011
Name:HARVILLA, JUDITH BERNADETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:BERNADETTE
Last Name:HARVILLA
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 1:5620 W THUNDERBIRD RD STE D4
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4640
Mailing Address - Country:US
Mailing Address - Phone:602-789-0880
Mailing Address - Fax:602-789-0891
Practice Address - Street 1:5620 W THUNDERBIRD RD STE D4
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4640
Practice Address - Country:US
Practice Address - Phone:602-789-0880
Practice Address - Fax:602-789-0891
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5275OtherAZ CHIROPRACTIC ID
AZ138738OtherMEDICARE PTAN