Provider Demographics
NPI:1548313794
Name:JUDGE, EDWARD P (DC, PC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:JUDGE
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 N HAYDEN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-2363
Mailing Address - Country:US
Mailing Address - Phone:480-990-8297
Mailing Address - Fax:480-990-8395
Practice Address - Street 1:2401 N HAYDEN RD STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-2363
Practice Address - Country:US
Practice Address - Phone:480-990-8297
Practice Address - Fax:480-990-8395
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3169R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0231040OtherBLUE CROSS BLUE SHIELD