1730295809 NPI number — MARGARET JOANN JUDGE D.C.

Table of content: MARGARET JOANN JUDGE D.C. (NPI 1730295809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730295809 NPI number — MARGARET JOANN JUDGE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUDGE
Provider First Name:
MARGARET
Provider Middle Name:
JOANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

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:
1730295809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
546 US HIGHWAY 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA SALLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61301-9629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-223-2998
Provider Business Mailing Address Fax Number:
815-223-2850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
546 US HIGHWAY 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA SALLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61301-9629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-223-2998
Provider Business Practice Location Address Fax Number:
815-223-2850
Provider Enumeration Date:
08/22/2006

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 , 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: 0005032014 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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