Provider Demographics
NPI:1811903818
Name:WOODRUFF, STEPHANIE BRADSHAW (DC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BRADSHAW
Last Name:WOODRUFF
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 1:1019 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5746
Mailing Address - Country:US
Mailing Address - Phone:843-571-5366
Mailing Address - Fax:843-571-5659
Practice Address - Street 1:1019 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5746
Practice Address - Country:US
Practice Address - Phone:843-571-5366
Practice Address - Fax:843-571-5659
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA08508433Medicare PIN