Provider Demographics
NPI:1104883404
Name:SOBOROWICZ, JUDY K (DC)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:K
Last Name:SOBOROWICZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 LONDON RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3521 LONDON RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7861
Practice Address - Country:US
Practice Address - Phone:715-834-6333
Practice Address - Fax:715-831-6374
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI350050962OtherRAILROAD MEDICARE
WI350050962OtherRAILROAD MEDICARE
WIU51112Medicare UPIN