Provider Demographics
NPI:1952985004
Name:JUDSON, BRETT MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:MICHAEL
Last Name:JUDSON
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 1:8237 W 3500 S
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-1851
Mailing Address - Country:US
Mailing Address - Phone:510-798-9999
Mailing Address - Fax:801-250-6092
Practice Address - Street 1:8237 W 3500 S
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-1851
Practice Address - Country:US
Practice Address - Phone:510-798-9999
Practice Address - Fax:801-250-6092
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36088111N00000X
UT13376067-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor