Provider Demographics
NPI:1790224434
Name:JUDSON FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:JUDSON FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-667-3636
Mailing Address - Street 1:133 LOUIS STREET
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4517
Mailing Address - Country:US
Mailing Address - Phone:860-667-3636
Mailing Address - Fax:860-667-3868
Practice Address - Street 1:133 LOUIS STREET
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4517
Practice Address - Country:US
Practice Address - Phone:860-667-3636
Practice Address - Fax:860-667-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty