Provider Demographics
NPI:1891790077
Name:JUDEVINE, JAMES H (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:JUDEVINE
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 1:1175 W STEELE LN
Mailing Address - Street 2:STE 4
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3553
Mailing Address - Country:US
Mailing Address - Phone:707-578-4156
Mailing Address - Fax:707-578-0723
Practice Address - Street 1:1175 W STEELE LN
Practice Address - Street 2:STE 4
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3553
Practice Address - Country:US
Practice Address - Phone:707-578-4156
Practice Address - Fax:707-578-0723
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0725022OtherTAX ID NO.
CADC24435OtherLICENSE NUMBER
CADC24435OtherLICENSE NUMBER
CADC0244350Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
CADC0244350Medicare UPIN