Provider Demographics
NPI:1972555134
Name:GENUNG, JUDITH D (DC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:D
Last Name:GENUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 E 53RD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2784
Mailing Address - Country:US
Mailing Address - Phone:563-359-1985
Mailing Address - Fax:
Practice Address - Street 1:1850 E 53RD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2784
Practice Address - Country:US
Practice Address - Phone:563-359-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA236584OtherMIDLANDS CHOICE
IA38959OtherWELLMARK BLUE CROSS BLUE
IA1137547Medicaid
IA236584OtherMIDLANDS CHOICE
IA1137547Medicaid