Provider Demographics
NPI:1053470922
Name:HEADRICK, MONIQUE (DC)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:
Last Name:HEADRICK
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 1:205 HUFSTETLER RD NE
Mailing Address - Street 2:
Mailing Address - City:RESACA
Mailing Address - State:GA
Mailing Address - Zip Code:30735-6524
Mailing Address - Country:US
Mailing Address - Phone:678-478-7676
Mailing Address - Fax:770-383-9113
Practice Address - Street 1:981 CASSVILLE WHITE RD NE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-7204
Practice Address - Country:US
Practice Address - Phone:678-478-7676
Practice Address - Fax:770-383-9113
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor