Provider Demographics
NPI:1336206796
Name:FUDGE, DEBORAH ANNE (DC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:FUDGE
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 1:100 MILK ST STE 8
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4600
Mailing Address - Country:US
Mailing Address - Phone:978-984-6636
Mailing Address - Fax:978-984-6486
Practice Address - Street 1:100 MILK ST STE 8
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4600
Practice Address - Country:US
Practice Address - Phone:978-984-6636
Practice Address - Fax:978-984-6486
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1173111N00000X
MACHI1173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAVAY35815Medicare ID - Type Unspecified