Provider Demographics
NPI:1942412283
Name:BOOTHBY, JUDITH W (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:W
Last Name:BOOTHBY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:BOOTHBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS DC PC
Mailing Address - Street 1:1620 SE ANKENY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1448
Mailing Address - Country:US
Mailing Address - Phone:503-233-0943
Mailing Address - Fax:
Practice Address - Street 1:1620 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1448
Practice Address - Country:US
Practice Address - Phone:503-233-0943
Practice Address - Fax:503-233-0943
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor