Provider Demographics
NPI:1336153568
Name:WATTENBARGER, JUDD (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDD
Middle Name:
Last Name:WATTENBARGER
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 1:4000 W DIMOND BLVD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-1474
Mailing Address - Country:US
Mailing Address - Phone:907-243-0660
Mailing Address - Fax:907-248-5481
Practice Address - Street 1:4000 W DIMOND BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1474
Practice Address - Country:US
Practice Address - Phone:907-243-0660
Practice Address - Fax:907-248-5481
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5785111N00000X
AK542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor