Provider Demographics
NPI:1700954989
Name:DOCHNAHL, JUDITH A (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:DOCHNAHL
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 1:4024 ESCH RD
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-8740
Mailing Address - Country:US
Mailing Address - Phone:563-587-8087
Mailing Address - Fax:563-587-8088
Practice Address - Street 1:4024 ESCH RD
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-8740
Practice Address - Country:US
Practice Address - Phone:563-451-6301
Practice Address - Fax:563-587-8088
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3435-012111N00000X
IA007484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI760712769028OtherBC BS GRP PIN
WI38903000Medicaid
WI760712769028OtherBC BS GRP PIN
WIU67647Medicare UPIN