Provider Demographics
NPI:1780790873
Name:MULLEN, JUDITH SANDERS (DOCTOR OF CHIROPRACT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:SANDERS
Last Name:MULLEN
Suffix:
Gender:F
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 GEORGE BUSH E #250
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-3302
Mailing Address - Country:US
Mailing Address - Phone:979-696-9400
Mailing Address - Fax:979-696-2233
Practice Address - Street 1:1700 GEORGE BUSH E
Practice Address - Street 2:#250
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-3302
Practice Address - Country:US
Practice Address - Phone:979-696-9400
Practice Address - Fax:979-696-2233
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T14966Medicare UPIN
601628Medicare ID - Type Unspecified