1114147436 NPI number — DR. JAMES EDWARD JUDGE D.C.

Table of content: DR. JAMES EDWARD JUDGE D.C. (NPI 1114147436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114147436 NPI number — DR. JAMES EDWARD JUDGE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUDGE
Provider First Name:
JAMES
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114147436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 E FOUNTAINVIEW LN
Provider Second Line Business Mailing Address:
SUITE 2B
Provider Business Mailing Address City Name:
LOMBARD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60148-5954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-252-7917
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2422 W, MAINE ST.
Provider Second Line Business Practice Location Address:
UNIT 4A
Provider Business Practice Location Address City Name:
ST. CHARLES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-252-7917
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38010847 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0004532422 . This is a "BCBS IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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