Provider Demographics
NPI:1255309068
Name:HELDRETH, JUDSON LANE (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:LANE
Last Name:HELDRETH
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 1:929 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2137
Mailing Address - Country:US
Mailing Address - Phone:803-356-8554
Mailing Address - Fax:803-356-8245
Practice Address - Street 1:929 N LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2137
Practice Address - Country:US
Practice Address - Phone:803-356-8554
Practice Address - Fax:803-356-8245
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2254111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2254Medicaid
SCCH2254Medicaid