Provider Demographics
NPI:1891863478
Name:SPRANDEL, JUDSON GRAHAM II (CHIROPRACTIC PHYSICI)
Entity Type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:GRAHAM
Last Name:SPRANDEL
Suffix:II
Gender:M
Credentials:CHIROPRACTIC PHYSICI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703
Mailing Address - Country:US
Mailing Address - Phone:330-455-4602
Mailing Address - Fax:330-455-2468
Practice Address - Street 1:1412 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703
Practice Address - Country:US
Practice Address - Phone:330-455-4602
Practice Address - Fax:330-455-2468
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0014675Medicaid
OH0014675Medicaid
0656442Medicare ID - Type Unspecified