Provider Demographics
NPI:1124248612
Name:STUCKY, JUDD A (DC)
Entity type:Individual
Prefix:DR
First Name:JUDD
Middle Name:A
Last Name:STUCKY
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 1:349 WEST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55964-1255
Mailing Address - Country:US
Mailing Address - Phone:507-534-3502
Mailing Address - Fax:
Practice Address - Street 1:349 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:MN
Practice Address - Zip Code:55964-1255
Practice Address - Country:US
Practice Address - Phone:507-534-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3306111N00000X
WI3210111N00000X
UT952941811202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor