Provider Demographics
NPI:1851468995
Name:JUDGE, CHARLES VINCENT III (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:VINCENT
Last Name:JUDGE
Suffix:III
Gender:M
Credentials:DOCTOR OF CHIROPRACT
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Mailing Address - Street 1:3 POST OFFICE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2756
Mailing Address - Country:US
Mailing Address - Phone:301-645-5393
Mailing Address - Fax:301-645-9490
Practice Address - Street 1:3 POST OFFICE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602
Practice Address - Country:US
Practice Address - Phone:301-645-5393
Practice Address - Fax:301-645-9490
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2018-06-14
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Provider Licenses
StateLicense IDTaxonomies
MD01688225100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM199OtherBCBS OF MD
MDT1630001OtherBCBS OF DC
MD781QMedicare ID - Type Unspecified