Provider Demographics
NPI:1114397098
Name:BRADBURN, JESSICA (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:BRADBURN
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 1:7580 CHARLOTTE HWY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7801
Mailing Address - Country:US
Mailing Address - Phone:803-380-4310
Mailing Address - Fax:803-380-4312
Practice Address - Street 1:7580 CHARLOTTE HWY
Practice Address - Street 2:SUITE 800
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-7801
Practice Address - Country:US
Practice Address - Phone:803-380-4310
Practice Address - Fax:803-380-4312
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor