Provider Demographics
NPI:1942583885
Name:MOSURE-JUDGE, DANA CRYSTAL (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:CRYSTAL
Last Name:MOSURE-JUDGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:CRYSTAL
Other - Last Name:MOSURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:219 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6341
Mailing Address - Country:US
Mailing Address - Phone:248-645-6070
Mailing Address - Fax:248-645-2949
Practice Address - Street 1:219 ELM ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6341
Practice Address - Country:US
Practice Address - Phone:248-645-6070
Practice Address - Fax:248-645-2949
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009849111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician