Provider Demographics
NPI:1174520266
Name:DAVIS, JUDD PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:JUDD
Middle Name:PAUL
Last Name:DAVIS
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 1:1675 S FISKE BLVD APT M153
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2573
Mailing Address - Country:US
Mailing Address - Phone:914-821-7393
Mailing Address - Fax:
Practice Address - Street 1:7335 W SAND LAKE RD STE 125
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5539
Practice Address - Country:US
Practice Address - Phone:497-930-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2023-04-11
Deactivation Date:2007-06-11
Deactivation Code:
Reactivation Date:2007-06-12
Provider Licenses
StateLicense IDTaxonomies
FLCH13154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU89139Medicare UPIN