Provider Demographics
NPI:1306185467
Name:BRADBURN, JOSHUA LEVI (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LEVI
Last Name:BRADBURN
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 1:5814 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4778
Mailing Address - Country:US
Mailing Address - Phone:910-791-9130
Mailing Address - Fax:910-791-9165
Practice Address - Street 1:2155 BRITTON RD STE 110
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-1929
Practice Address - Country:US
Practice Address - Phone:910-408-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor