Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301009205 | MI |
N | 111N00000X | Chiropractor | CH00034638 | WA |
NPI | 1003828047 |
---|---|
Provider Name | Dr. Daniel J Judge |
First Address | Ferndale, MI 48220-1612 |
Second Address | Birmingham, MI 48009-6902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 27/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0211795 | DEPT LABOR & INDUSTRIES (01) | WA |